October 11, 1999
Dangerous to our health
Congressional remedies like medicine from the Dark Ages
If Congress practiced medicine, they'd be using leaches on their patients and offering bullets for amputee candidates to bite before hacking off irreparable limbs.
Of course, this past week one would have thought the US House -- composed primarily of lawyers -- was instead a convention of the American Medical Association, with Members of Congress attempting to legislatively practice medicine. Yet what was completely ignored in the debate was that this was a clear case of malpractice.
No one disputes the diagnosis: American health care is in lousy shape. As a practicing physician for more than 30 years, I find the pervasiveness of managed care troubling, if not reckless.
What made last week's congressional action the equivalent of medical malpractice was that the people operating on the "patient" were the same ones responsible for injury. American health care became what it is today not as a result of too little government intervention, but rather too much. Contrary to the claims of many advocates of increased government regulation of health care, the problems with the health care system do not represent market failure. Rather, they represent the failure of government policies that have destroyed the health care market.
To think that by creating a new level of government bureaucracy -- which all the plans did -- will magically solve the problems is analogous to assuming a wolf can guard the sheep without disastrous consequences ensuing.
No one can take a back seat to me regarding the disdain I hold for the HMO's role in managed care. This entire unnecessary level of corporatism that rakes off profits and undermines care is a creature of government interference in health care dating to the 1970s. These non-market institutions could have only gained control over medical care through collusion between organized medicine, politicians, and the profiteers, in an effort to provide universal health care.
But the government intervention in health care pre-dates the 1974 Employee Retriement Income Security Act (ERISA), with Congress granting tax benefits to employers for providing health care, while not allowing similar incentives for individuals. As such, government removed the market incentive for health insurance companies to cater to the actual health-care consumer. As a greater amount of government and corporate money has been used to pay medical bills, the costs have artificially risen out of the range of most individuals.
Only true competition assures that the consumer gets the best deal at the best price possible by putting pressure on the providers. Once one side is given a legislative advantage in an artificial system, as it is in managed care, trying to balance government-dictated advantages between patient and HMOs is impossible. The differences cannot be reconciled by more government mandates, which will only make the problem worse.
Patients are better served by having options and choices, not new federal bureaucracies and limitations on legal remedies. Such choices and options will arrive only when we unravel the HMO web rooted in old laws, and then change the tax code to allow Americans to fully deduct all healthcare costs from their taxes, similar to what is already allowed for employers.
While neither the current system, nor the mess produced by the House vote last week, constitutes traditional socialism, it is rather something almost worse: corporatism. As government bureaucracy continues to give preferences and protections to HMOs and trial lawyers, it will be the patients who lose, despite the glowing rhetoric from the special interests in Washington, DC. Patients will pay ever rising prices and receive declining care while doctors continue to leave the profession in droves.
If Congress is going to continue to meddle in medicine, then perhaps we should require new Members to take the Hippocratic Oath. But given their resistance to upholding the Constitution, it's doubtful they would pay much attention. Sadly, we can expect Congress to continue to apply leaches to our wallets and amputate whatever good remains in American health care.