American Elephants

Top Down Mandates or Bottom-Up Choice? by The Elephant's Child

We are a nation of something around 310,000,000 people.  How many people do you know with whom you agree completely on everything?  Yes, I thought so.  To me that suggests that there is something deeply wrong with the assumption that  you can fix everything with lots of rules and mandates established by wise but faceless bureaucrats in Washington DC.  We have a hard enough time enforcing the laws that everybody pretty much agrees on.

The Liberals’ theory is that a big and encompassing government can protect all the stupid and vulnerable people from their own folly and the troubles they encounter with wise and careful laws and regulations.  Republicans consider that to be folly, and think people will do fine on their own with only a minimum of laws that are fully enforced.  Liberals think that is mean and hard and unfair and Republicans should stop eating babies and let the people who know better run things.

Well, I drifted off there a little, but you get the general drift.  My Grandfather was a doctor, horse and buggy type, who did the best he could to take care of people who, accustomed to the wide-open spaces and vast mountains of the West, were generally pretty healthy except for the usual amount of sprains and breaks, wounds and babies. Which was just as well because his supply of palliatives to deal with illness and disease was not large. Antibiotics and diagnostic machines were unheard of, aspirin was new and sulfa and penicillin were far in the future. He was a good diagnostician, and fixed what was fixable at the time.

So how did we get here, with all sorts of miraculous medicines, tests and diagnostic machines to determine what might be wrong. Within a few blocks of my house you can find an acupuncturist, two drug stores, a chain store that sells only dietary supplements, a couple of chiropractic offices and a foot doctor, and eye doctor and a couple of dentists. Three hospitals are about fifteen blocks away, with all the medical practices and supporting businesses that accompany hospitals.

The problem with ObamaCare is that it has no proven ways to keep health care costs down.  So what happens when it goes into effect in 2014?  The best guide we have is Massachusetts, whose 2006 health-care overhaul was the model for ObamaCare. RomneyCare attacked the problem of “the uninsured” by fining them and their employers for their lack of being insured. It also subsidized premiums to make it possible for the uninsured to avoid paying the fine.

Costs have skyrocketed far beyond 2006 projections.  The administrators’ solution is to raise taxes, increase fines on employers, and put price controls on insurance premiums, which would force the insurers to further cut their reimbursements to hospitals and doctors. The flood of new patients and  the government’s underpayment for treating them has resulted in a critical shortage of doctors. And patients who cannot find doctors head to the emergency room.

The Harvard School of Public Health has issued a report on the urgent need for a comprehensive, unified, enforceable, inescapable tax-financed system to control every component of health care that a state can realistically control. An “independent board” should define the benefit packages and provider payments, set the budget that will determine the payroll tax rates.  This all powerful board will include all the major players.  There, that will fix everything. It is the inevitable liberal solution to a mess that they have created.

We really have quite a bit of experience with top down systems of control. Imposing an all-controlling and all-embracing system to control the lives and behavior of large numbers of people has never worked well.  We already have a critical shortage of doctors, particularly those who are willing to treat Medicaid patients. So ObamaCare plans to add another 18 million uninsured to the Medicaid rolls.  Medicaid is a shared a shared state-federal program created in 1965 designed as a limited safety-net program for low-income Americans.

At the state level, Medicaid spending consumes nearly a quarter of state government budgets.  One in four Americans in on Medicaid.  Federal mandates often preclude alternatives developed by states to save costs.  The Centers for Medicare and Medicaid services make it impossible for states to innovate.  The proponents of ObamaCare do not consider state flexibility and innovation to be useful for effective reform.

It always seems to the fixers that everything could be made better with the proper set of regulations.  And it never, never works.  How about a bottom-up consumer-driven system? A what?  You could call it freedom, surely that is a familiar term.


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