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It’s not a health care crisis; it’s a payment problem

(Chicago Tribune) – President-elect Barack Obama and Health and Human Services secretary designee Thomas Daschle want public suggestions on how to fix the healthcare crisis.

Here’s one: Don’t. There is no healthcare crisis there’s a sickness payment problem. Americans are able to choose what cars to buy, groceries to purchase, homes to own or rent, and make innumerable other transactions in freedom. Why not medical insurance? Government decisions about interest rates, mortgage qualifications, bank regulation and more contributed to the current Great Recession. So we want the feds to manage America’s vast medical care and health insurance industries?

Two-thirds of Americans are overweight, half of that number obese. Forty percent do not exercise. Twenty percent still smoke. About 18 percent don’t wear safety belts. Rates of chronic and degenerative illness and avoidable injuries rise. One estimate puts preventable medical costs at 70 percent of the total. Americans spend an average $7,000 annually on “health care,” 16 percent of gross domestic product. That’s the world’s highest, and twice the per capita spending of Japan, where life expectancy is 83 years, compared to our 77.9. Unless blocked, the federal government will do what it does best, cost-shifting to buy votes like bailing out poorly run banks and auto companies with taxes raised in part from better-run banks and auto companies.

Forcing all Americans into one insurance scheme robs the responsible to subsidize the irresponsible. When life insurers discriminate between smokers and nonsmokers and auto insurers charge higher rates for the reckless than the cautious, they discourage smoking and speeding and promote healthier living. Universal coverage with equal access will subsidize unhealthy choices, its effect similar to the higher prices retailers impose on honest shoppers to cover losses by shoplifters.

When the feds enjoyed a monopoly on mail, it could take weeks for letters and packages to cross the country. With the arrival of private competitors such as UPS and FedEx, overnight delivery became common, even by the U.S. Postal Service. After the court-ordered breakup of the Bell Telephone Co. monopoly, one no longer needed to choose between a limited number of phones and wait a week or two for installation. Instead, one could select from a variety of high-quality low price models at electronics stores, arrange service from competing companies, and plug the new phone in without delay. That new freedom led to the cell phone revolution.

Why go backward with health insurance? When a Republican Congress and Democratic President Bill Clinton curtailed welfare as an entitlement in 1996, editorialists, academics and polemicists warned of danger for the poor. But people did not go from welfare rolls to starving on the streets. Having ended the costly dependency of welfare recipients on government, we now insist on making the middle class a ward of the state through health insurance. Expect higher taxes, stagnating growth and, inevitably, “rationed care” (that is, denied care) as in Great Britain. There, bureaucrats could deem a woman “too young” for the Pap smear that would detect her cervical cancer, senior citizens “too old” for transplants now routine here and millions could not get dental care. Not because dentists weren’t available, but because they’d already fulfilled their work quotas. Of the estimated 45 million people in this country without health insurance, many are young adults who decide

not to buy. Many others are illegal immigrants. And many are working poor who can’t afford it. For them, and the rest of us, don’t eliminate choice. Increase it. Let insurers compete more readily across state lines. Help individuals participate in buying pools. Grant tax advantages for “wellness care” and high deductible major or catastrophic coverage. Use screening physicals to price policies according to behaviors. Above all, separate health insurance from employment. Pay those “fringe benefit” dollars directly to workers and let free Americans buy our own health insurance in a more competitive market. We do so for car, life, and home insurance. It’ll be cheaper, more efficient and a lot more democratic.