Whatever the problems with the roll out of Healthcare.gov, the fact is that the government take-over of health care has been happening for more than a century. If we want a truly free market for health care, we have to think in broader and bolder terms than simply rolling back the ACA. With that in mind, here is a short list of patient-focused ways to get the government out of health care.
Abolish Medicare. By guaranteeing that older people get health care, Medicare distorts the entire system in favor of geriatric diseases. In my experience as an IBD patient, the median age for most gastroenterology patients is just under a century. This means doctors are better trained and equipped to deal with oldstersʼ problems, and less invested in their young patientsʼ problems. Abolishing Medicare would level the playing field for all patients — not just those favored by the government.
End FDA regulation. Currently there are two excellent medicines for IBD, which lack FDA approval — meaning their sale is illegal. This is an artificial constraint on the quality of my health care; in essence a prohibition against those medicines. Eliminating mandatory FDA approval would allow the free market to determine which medicines work and which donʼt — not the government.
End “prescriptions” for medicines. The FDA also decides that some medicines can be sold only with prescription. This artificially limits the supply and availability of those medicines. In my case, I know exactly what medicine I need to take: why should I pay a government-licensed doctor to write down what I already know, then pay a government-licensed pharmacist to read it back to me? It should be the responsibility of individual consumers to decide which medicines they take — not the government.
Defund government research for medical conditions. By choosing which diseases to focus on, the government tilts the field in favor of pet causes and conditions. Consider the imbalance between AIDS research funding and that for sickle-cell anemia, which clearly favors one special-interest group over another. The government could still fund basic research on biology and physiology, but should not play God. Let the market decide which diseases need more research — not the government.
Disallow patents for medical innovations. Patents are government-enforced monopolies over an invention; when it comes to medicines and medical supplies, this means the government chooses who can provide needed care. Right now several important IBD drugs are protected by patents, even though they all do basically the same thing. Competition means lower prices, but patents keep prices high for these medicines — much like mandatory FDA approval. We should eliminate patents to allow the market to decide who profits from innovation — not the government.
Ignore medical school accreditation. States typically license physicians only from accredited schools; moreover, certain federal loans and grants are only available for students in accredited medical schools. Yet accredited schools are producing doctors at the same rate they were 30 years ago – despite a nearly 40% increase in population. This artificial restriction on the supply of physicians is pushing our health care system into crisis; it is especially getting harder for patients like me to find primary care physicians. The free market — not the government — should decide which schools can train physicians.
End mandatory physician licensure. This one is Milton Friedmanʼs idea: anything that constrains the supply of providers increases the cost of health care, so government-mandated physician licensure is an unnecessary interference in the market. The AMA and other professional societies could offer certification on a voluntary basis, though I pay little attention to diplomas or board certification anymore: I look at whether the physician is in-network, and their reviews on Angieʼs List. Where is the value-added from a government license? The market would decide which certification processes work and which do not — not the government.
Free-market advocates understand that each government intervention in health care represents a distortion — often with the effect of raising prices and restricting care for the most needy patients. To fix our system, such interventions have to be weighed in the context of a proper free market system, and must not be tolerated merely because they are already law. Thatʼs the problem with the government take-over of health care: itʼs a slippery slope. First you require physician licenses, then start an FDA, then Medicare — and soon Healthcare.gov seems like a good idea.
Real market reform is not simply a matter of repealing the latest government outrage, but instead tearing the whole rotten system down and building a brand-new, free-market system from the ground up. Every government program or rule for health care represents a market distortion that must be justified — in market terms — or be abolished. That is the only realistic path towards a market-driven health care system.
“Duncan Cross” blogs from the perspective of a chronic patient at his self-titled site, Duncan Cross.