I like Donald Trump. In fairness, I like Ted Cruz too and would love to see a Trump/Cruz ticket, but this column is for "The Donald."
The more the orthodox GOP establishment hate Trump, the more I like him. Years ago I read Trump's book, "The America We Deserve." At the time, over 15 years ago, I thought he hit the nail on the head for most things, from education to business – he touted free-market capitalism as the basis for freedom and prosperity – right up until the chapter on health care when he became a socialist. Back then, I understood that it was easy – even for smart people like Mr. Trump – to get lost in the convoluted realm of medicine. But today, it's important he get it right. So let me take this opportunity to simplify the issues of health care for Donald Trump who is known for "cutting to the chase." Here are ten principles in a nutshell.
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- Medicine is between a physician and a patient. Everything else is supportive fluff. And at the end of the day, if a system is bad for physicians, it is bad for patients.
- No matter how high and mighty your motives, it is unethical to steal from some people to give to others. Today we have a medical system based on theft. We take from working-class families to give medical care to seniors and others. We used to reach into our own pockets and hearts to provide charity, now we do it with the IRS. That is not charity.
- The cost of medical care skyrocketed after the full implementation of Medicare. The reasons are simple. Medicare is a government monopoly – the highest trained doctor and the lowest get paid the same for the same procedure. (Prices have come down in those areas of medicine open to competition.) And Medicare alone has spawned over 160,000 pages of regulation that carry the force of law. The price of compliance and billing in that regulatory nightmare increases the cost of everything from Band-Aids to surgeons' fees. As a black hole is so dense no light escapes it, medicine is so over-regulated that little real care is being given. Hospitals were once mostly patient care areas; today they are mostly administrative with fewer and fewer beds and clinical suites.
- Medicine is not a right. It is a commodity. Our rights – such as freedom of speech – are enforced by law and if necessary by force. But enforcing freedom of speech does not infringe on the rights of others. If medicine is a right, then to enforce that right, others could be enslaved to perform the care. Not enough surgeons? No problem, we force more to be trained against their will. Not enough nurses? No problem, work longer hours until patients are cared for. And so forth. A right does not infringe the rights of others.
- As a commodity, medicine responds to the basic laws of economics. The first law is that taxation always results in less of whatever is taxed. Put a tax on luxury craft – less people buy luxury craft. Tax health care, get less health care. The second law is that free markets work because the millions of people in the market can adjust for the minute to minute changes in the conditions, and central planning always fails because a few smart people at the top are not better at managing complex systems than the millions of people at the bottom. Central planning failed the Soviets in deciding how many tractors to build, so crops were left rotting in the fields and people starved. Today we have shortages of everything – supplies, medicines and doctors. We are short of nearly every sub-specialty of medicine – surgeons, physiatrists, neurologists, rheumatologists, etc. And (among other things), this is because the government, since the 1970s, as a cost-containment scheme, decided to control (and limit) the number of specialty training positions. Because medicine is about a 15-year pipeline, the effect of bad planning ripples down decades.
- Doctors' practices and hospitals must be economically viable to be able to offer their services. The university doctor wonks who suggest all the policies don't pay their own overhead and have no idea how much it costs to actually see patients. (The Harvard HMO was the first to fail in years past.) Every government idea to be foisted on the medical profession (the worst is Electronic Medical Records) has made us more inefficient and more costly.
- Everywhere it has been in force, government medicine puts the needs of the group above the needs and basic human rights of the individual patient. It replaces Hippocratic ethics by the Utilitarian ethic that puts the doctor in the position of denying care to some for the benefit of others. And it gives the untrained bureaucrat control over the practice of medicine – at the loss of the very things government "experts" purport to offer – quality, cost control and access (all demonstrably get worse under government).
- There is no constitutional authority for the federal government to involve itself in medicine in any way – payment, regulation, or practice guidelines and oversight. Therefore it is disingenuous to say that Obamacare is unconstitutional but Medicare is not. And it is just as wrong to "repeal and replace." You have no authority to replace this mess with any other mess.
- We don't need to stop Obamacare – although it would be great to just throw out all that legislation. We need to get out of government medicine entirely and return to a system of the 3 C's: Cash, Catastrophic Insurance and Charity. That is the way we developed the greatest medical care in the world – not by creating a system, but by allowing private individuals the freedom to care for others, and for individuals and communities – not the federal government – to assist the poor. (See http://www.jpands.org/vol17no3/hieb.pdf).
- You may not be able to untangle the Gordian knot of Obamacare Legislation, but if you allow the freedom for doctors to practice outside the government system, and you allow patients freedom to seek care outside the government system (which currently they do not have), then Obamacare, Medicare and Medicaid become background noise, and those who wish to avoid the hazards of the government system can simply opt out. If you allow the federal government to force everyone – doctors and patients alike – into the Sovietized system, then not only health care, but freedom itself is doomed in America.
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