I heartily recommend Freedom and Individual Rights in Medicine to anyone who wants affordable health care and the right to make their own health care decisions. FIRM "promotes the philosophy of individual rights, personal responsibility, and free market economics in health care. FIRM holds that the only moral and practical way to obtain medical care is that of individuals choosing and paying for their own medical care in a capitalist free market. Federal and state regulations and entitlements, we maintain, are the two most important factors in driving up medical costs. They have created the crisis we face today."

Here is an excerpt from an article (Moral Health Care vs. “Universal Health Care”) by FIRM's founders Lin Zinser and Paul Hsieh.

Although American scientists, doctors, and businessmen have produced the most advanced medical technology in the world, American health care is in a state of crisis. Technologically, we are surrounded by medical marvels: New “clot buster” drugs enable patients to survive heart attacks that once would have been fatal; new forms of “keyhole surgery” enable patients with appendicitis to be treated and discharged within twenty-four hours, whereas previously they would have spent a week in the hospital; advances in cancer treatment enabled bicyclist Lance Armstrong to beat a testicular cancer, which, had he lived fifty years ago, would have killed him; and so on.

From an economic perspective, however, such medical treatments are increasingly out of reach to many Americans. Health care costs, as reported by the New York Times, are rising twice as fast as inflation.1 And health insurance, as reported by USA Today, “is becoming increasingly unaffordable for many employers and working people.”2 A decreasing percentage of employers are offering health insurance benefits to their workers, and many of those who are offering benefits are requiring their employees to pay a greater percentage of the costs.3 The U.S. Census Bureau reported in 2007 that nearly forty-seven million Americans had no health insurance, a sharp increase of ten million people from a mere fifteen years earlier.4 In short, there is a major disconnect between existing life-saving medical technology and the ability of Americans to afford it.

This discord is affecting doctors as well. The American Medical Association warns physicians that, due to the lack of affordable health insurance, “more patients will delay treatment and . . . doctors will likely see more uncompensated care.”5 Hence, each year doctors are working harder and harder but making less and less money, resulting in a “critical level” of stress and burnout. According to a recent survey of doctors, “30 to 40 percent of practicing physicians would not choose to enter the medical profession if they were deciding on a career again, and an even higher percentage would not encourage their children to pursue a medical career.”6

Total spending on health care in the United States amounts to nearly 17 percent of the entire economy, and this is expected to rise to 20 percent by 2015, “with annual spending consistently growing faster than the overall economy.”7 Because of skyrocketing health care costs, the U.S. federal Medicare trust fund is expected to go bankrupt in 2019, less than twelve years from now, potentially leaving millions of elderly Americans without health insurance coverage.8 American health care is in dire straits and will continue to worsen—unless Americans demand fundamental political change to reverse the trend. Unfortunately, the kinds of changes currently being proposed by politicians will only exacerbate the problem.

Politicians from across the political spectrum, including Democratic presidential candidate Hillary Clinton and Republican candidate Mitt Romney, have argued that the government should guarantee “universal coverage” to all Americans, making health care a “right.”9 And politicians are not alone; numerous businessmen, union leaders, and insurance executives are united in saying that this will solve our problems.10

It will not.

Contrary to claims that government-imposed “universal health care” would solve America’s health care problems, it would in fact destroy American medicine and countless lives along with it. The goal of “universal health care” (a euphemism for socialized medicine) is both immoral and impractical; it violates the rights of businessmen, doctors, and patients to act on their own judgment—which, in turn, throttles their ability to produce, administer, or purchase the goods and services in question. To show this, we will first examine the nature and history of government involvement in health insurance and medicine. Then we will consider attempts in other countries and various U.S. states to solve these problems through further government programs. Finally, we will show that the only viable long-term solution to the problems in question is to convert to a fully free market in health care and health insurance.

Almost everyone says that you must have health insurance. Here is why that isn't necessarily true:

• If you have a family to insure or are over age 50, you can buy quite a bit of health care for the same amount you will pay for premiums, deductibles, and copays under Obamacare.

• If people paid directly for their own health care, prices would plummet. About 50% of the prices you are charged are for overhead—much of it the office staff and systems needed to track insurance claims. Hospitals and doctors would be forced to publish and guarantee their prices. Competition—the only genuine means of driving down prices without sacrificing performance and quality—would ensue.

• Hospitals set highly inflated prices because that gives them negotiating leverage with insurance carriers. No one—not even the wealthiest—really pays those prices. Many hospitals will give you an automatic 25% discount just for being a self-pay patient. Many doctors will negotiate a 50% discount if you pay directly. Depending on your income and outstanding bills, you may be able to obtain even higher discounts. Demand an itemized bill.

• Hospitals and physicians groups are happy to accept monthly payments. Those who pay for their own health care establish personal credit with local hospitals and doctors. People who pay for their own health care receive better service. These things could come in handy if the government begins denying expensive health care services to older or sicker patients insured under Obamacare.

• You may be able to enhance your standing with your preferred hospital by doing volunteer work, fundraising, and/or making regular donations.

• Yes, there are risks associated with being uninsured. Uninsured patients are usually disqualified from receiving organ transplants. Long hospital stays are rare these days—less expensive home care is usually, but not always, an option. Be sure you fully understand the risks before choosing to be a self-pay patient.

The public was told that we needed Obamacare to enable people with pre-existing medical conditions to get health care. That's not quite true.

Two-thirds of the states had high-risk health insurance pools for people with pre-existing medical conditions. These programs were severely undersubscribed. The average state had fewer than 10,000 enrollees. The total number of enrollees in the 30+ states was roughly 250,000. That's a small number compared to the 48 million Americans said to lack health insurance.

Obamacare also included an interim federal high-risk health insurance pool. That means that since 2010 anyone in the United States with a pre-existing medical condition could buy health insurance. The Pre-Existing Condition Insurance Plan (PCIP) was also severely undersubscribed. (The enrollee numbers were consistent with the state high-risk pool numbers.)

Comparing Obamacare plans to the high-risk pool plans shows that there is very little savings for people with pre-existing medical conditions. The premiums are about the same. The deductibles and copays for Obamacare appear to be slightly lower. However, in some scenarios a person with a pre-existing medical condition pays more under Obamacare.

For example, the Missouri Health Insurance Pool (MHIP) has a coinsurance requirement while Obamacare has a copayment requirement. Under Obamacare, a patient must pay a portion of the bill whenever they visit a doctor. Under MHIP, there is no copayment due at the time of the visit, but after the patient meets their deductible they are responsible for 20% of the bills up to a limit. Both Obamacare and MHIP have out-of-pocket maximums: The maximum under Obamacare is lower, but the patient starts paying out-of-pocket sooner.

A permanent federal high-risk health insurance pool would have ensured that anyone with a pre-existing medical condition could buy health insurance. This could have been accomplished without imposing mandates on employers and individuals, and without providing waivers to select companies and government employees.

Mobile Health Marketplace has a concise and well organized directory of mobile health apps and devices. The directory covers apps for health and wellness, illnesses and injuries, medical treatment support, and workplace health and safety.

An interview last month with Rick Valencia, VP and GM of Qualcomm Life, at U-T San Diego offers insights about why some big names are investing in wireless health—and why success has so far been elusive.

Valencia sees wireless health serving different purposes in different settings. In developing countries, it provides access to care in remote and rural areas. In developed countries, wireless health has the potential to reduce the cost of care by helping people stay well and providing services outside of expensive “acute care settings” (hospitals and emergency rooms).

Honeywell HomMed has made a similar point. Remote monitoring can be used to avoid hospitalizations by detecting problems before they become acute and to shorten hospital stays by allowing patients to be released earlier (to be closely followed at home).

Qualcomm’s 2net Hub and new 2net Mobile devices suggest that the industry still needs help connecting mobile and remote devices to the network and managing them.

Valencia’s last comment was interesting but enigmatic. He said that under new health care laws we are moving away from fee-for-service to a “capitated” environment. In the past, when a patient showed up it was a revenue opportunity. In the new system, when a patient shows up it will be viewed as a cost. Valencia believes this will motivate physicians and hospitals to reduce costs. “They can make a choice to pay for something and not get reimbursed at all if they know that by paying for that, it is going to bring down the total cost of care.”

Valencia is right in that consumers will do everything they can to avoid expensive acute care settings. But I don’t see how a “capitated” (top-down) environment will lead to lower costs. It may seem counterintuitive to many people, but experience shows that (regardless of intentions) top-down systems end up being wasteful and expensive. Competition is the only force that drives down prices to the marginal cost.


UPDATE (December 17, 2013): Eureka! (Or perhaps I should say "Duh!"). When Valencia refers to a "capitated" system he means one in which doctors are paid by the head rather than for specific services rendered. Yes, this will certainly motivate doctors and hospitals to reduce costs. (Though they can do that simply by withholding services.) I have just started reading Your Doctor Is Not In by Jane Orient which presents a glossary at the beginning and defines "capitation" as a feature of some national/socialist/managed health care systems.

Armed with this more specific definition, I think Valencia is way too optimistic if not flat out wrong. In a capitated system, doctors will spend as little of their own money as possible. They are unlikely to invest in infrastructure just because they believe it might reduce costs. Instead, they may lobby bureaucrats to implement wireless health by decree. In the absence of market forces (and the corrective feedback that entails), wireless health will become just another government boondoggle.

President Obama and top Democrats promoted Obamacare as a boon for people with pre-existing medical conditions. Finally, people with pre-existing medical conditions could “get health care.” However, the sales pitch ignored two key facts. No one in the United States is denied life-saving treatment just because they are unable to pay. And two-thirds of the states already had high-risk health insurance pools.

It’s hard to compare the cost of Obamacare plans to the state high-risk pool plans that are now being phased out. There are multiple plans and they are structured differently. The total out-of-pocket expenses for Obamacare plans appear to be somewhat less than the total out-of-pocket expenses for the Missouri Health Insurance Pool (MHIP) plans that I examined.

What’s interesting is that the Obamacare plans, which do not discriminate against people with pre-existing conditions, resemble the high-risk pool plans. A middle class family that doesn’t qualify for a subsidy could end up spending $20,000 per year on health care despite being insured and having no pre-existing conditions.

The Obamacare plans may hurt people with pre-existing conditions in other ways. For instance, some Obamacare plans restrict coverage to a local network. People with genetic disorders, many of which are life-threatening, need the freedom to visit out-of-network physicians who have significant experience or who are developing new treatments. There are also higher copayments for visiting specialists--something that people with pre-existing conditions are more likely to do.

People with pre-existing conditions will suffer disproportionately if Obamacare leads to problems predicted by some critics such as waiting lists and rationing. Some may even be denied treatment and sent home with a bottle of pain pills as a presidential candidate once suggested.