Both parties have proved Congress and the president cannot give us a health care system that works. Let’s try fixing it among the states. We have nothing to lose.
No one has to convince Colorado Gov. John Hickenlooper, a Democrat who has been working with Republican Ohio Gov. John Kasich to form a bipartisan group of governors to lead a health care overhaul.
“It’s time to roll up our sleeves and deliver specific plans that will improve our health insurance system by lowering costs and providing stability for the marketplace,” Hickenlooper said in a statement Friday, after the epic failure of Republican senators who promised to overturn Obamacare. “As governors, we are on the front lines of this debate. We must move forward in a transparent, collaborative, bipartisan manner to address problems we can all agree need fixing.”
Hickenlooper and Kasich, who each oversee key swing states, are right to commandeer this issue from federal authorities who have made things worse.
Our only concern with Hickenlooper’s statement is his emphasis on improving our “health insurance system.”
Please, work to enhance competition and lower prices among insurers. That is an essential goal.
Here’s the problem. Nearly all politicians seem to view “insurance” distribution and regulation as the sole or primary dilemma in our escalating health care crisis. Hickenlooper, a successful business entrepreneur, has an opportunity to broaden the context.
The soaring cost of insurance is merely one symptom of a more serious ailment. Fixing insurance as the first and final goal amounts to treating the fever but not the disease.
Insurance and health care are confused as the same because health care costs have risen over decades, with no correlation to the Consumer Price Index.
The cost of care long ago rose to the point few can afford common medical procedures out of pocket. Politicians don’t even talk about care, the price of care and the availability of care. They talk about Medicaid, failed insurance exchanges, tax breaks and subsidies to buy insurance.
The result is a market of health care providers residing in a fantasy universe devoid of market controls and the benefits provided when entrepreneurs rush to solve problems and satisfy market demand. Ever-increasing subsidies, aimed at easing the pain, push prices higher. It is like college tuition, which goes up with every government attempt to help consumers pay the cost.
Colorado has expanded insurance coverage, sacrificing essential transportation investments and other public works projects to extend Medicaid far beyond the disabled and poor. We attempted a faux market of insurers competing for customers subsidized by government, called Connect for Health Colorado. We flooded the market with insurance, only to endure soaring premiums and deductibles so high millions of insured Coloradans avoid care because they cannot afford the out-of-pocket costs.
As middle-class wage earners sweat plasma paying for largely useless insurance policies, they also pay for able-bodied, working-aged adults to enjoy Medicaid — a single-payer health care system available to anyone with sufficiently low income. Some upper middle-class and wealthy Coloradans get Medicaid if their incomes qualify, while they live commfortably off of business assets or other non-income treasures. We can’t describe the disfunction of Obamacare any better than former President Bill Clinton.
“You’ve got this crazy system where all the sudden 25 million more people have health care and then the people are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half,” Clinton said. “It’s the craziest thing in the world.”
Health insurance is not care, and governors must know as much. They can distribute policies all they want, and it won’t bring down prices and ease access. Insurance is worthless if it is not backed by actual care.
If governors want better access and lower prices for all constituents, they should limit government safety net insurance for the legitimately poor, disabled and elderly. They should seek to enhance competition among private insurers.
Just as importantly, if not more so, governors should try to ignite a state-by-state supply side tsunami of care that ensures lower prices and easier access for all.
Visualize health care clinics in most major strip malls, so numerous young physicians, physician’s assistants and nurse practitioners would compete for patients. More competition would reduce wait times for appointments and reduce costs of routine care and procedures.
Governors should review all state and federal regulations, seeking to undo nonessential barriers to medical startups. More than half of states enforce “certificates of need” laws, for example, which require government approval for new medical businesses. States pick winners and losers, and consumers typically lose. Colorado eliminated this barrier and the result has been more urgent care clinics, stand-alone emergency rooms and other modern health care options.
Governors should look for programs to make underserved markets more enticing for physicians and other care providers, by working with lenders to offer low-interest, low-risk financing for startup health care ventures and homes for health care providers. Work with local governments and the business community to devise programs that help rural health care professionals in repayment of medical school loans.
Look to safely enhance the responsibilities of registered nurses, perhaps empowering them to write common prescriptions.
Increase the capacity for enrollments in the medical programs at state universities.
Encourage fire departments to run wellness clinics in stations and substations staffed with paramedics.
Turn every stone in pursuit of creating more health care, unleashing the benevolent forces of surplus and competition.
Congress and presidents have not resolved our health care mess by tweaking with insurance.
It is time to invoke the laboratory of states.
Governors, think far outside the box. Work with business leaders, philanthropists, medical professionals, and local, state and federal officials without regard for partisan politics. Give us a better market of insurance. Mostly, give us a better market of care.
THE GAZETTE EDITORIAL BOARD
When President Clinton left the White House, his staff removed the “W” keys from all computer keyboards, and did approximately $15K worth of damage.In 1996, the NY Times crossword featured the election winner’s name as a clue, despite not yet knowing who won the actual election.