Only Liberty Can Loose the Gordian Knot of Health Care Reform

Published July 25, 2017

Welcome to the final issue of the Consumer Power Report.

Anyone acquainted with the complexity of health care policy debates in Washington, DC and the 50 states can appreciate the legend of the Gordian knot.

Legend holds (and reminds us) that when Alexander the Great and his men entered the city of Gordium (in modern-day Turkey) in 333 B.C., the challenge of untying a famously complex knot obsessed the young general. The knot—really a series of knots inextricably woven—served as the hitch of an ancient wagon once owned by Gordius, father of King Midas, whose touch transformed objects and people into gold. The person who figured out how to untie the knot would one day rule all of Asia, according to one oracle. After struggling with the knot, Alexander finally drew his sword and sliced it in half with one clean stroke. He went on to conquer Asia.

Large-scale reforms of the United States’ health care system are a Gordian knot that only a renaissance of liberty can loose. We ought to know this, because we have tried everything else.

Our knotty health care system (which is also a considerably naughty system) is engaged in a great tug of war. If you expand health insurance coverage to the poor, you impoverish the masses. If you swing wide the gates for uninsurable people to buy health insurance, you shut the door on healthy people wanting inexpensive, catastrophe-only insurance. These are policy knots. There are others.

Even on the rare occasion a policy solution seems obvious, political knots remain. It profits House Speaker Paul Ryan (R-WI) nothing to whip 200 Republican votes without securing almost 20 additional conservative-libertarians or centrists. In the Republican-controlled Senate, Democrats may as well hold a majority of seats, so devastating to the GOP agenda is the tyranny of the filibuster, which Senate Majority Leader Mitch McConnell (R-KY) has naively left intact.

Lawmakers, health care providers, and patients have countless opinions on how to untangle our health care system. These opinions fall roughly along two channels. One focuses on the problem, the other on the solution.

Wise as focusing on the problem may sound, this strategy is fatally flawed when applied to our health care system, because it accepts our flawed system’s flawed rules of engagement. The most egregious flawed rule is the widespread conflation of health care and health insurance by members of Congress and the media. The myth that having a robust health insurance policy is cost-effective or essential for low- and middle-income Americans to obtain quality care is a Trojan Horse. Congress’ insistence on insurance as the basis of our health care system is our Achilles’ heel.

Congressional Republicans have granted faulty premises most recently codified by the Affordable Care Act, and previously codified by a half-century of entitlement spending and tax breaks for employer-provided health insurance. Faulty premises include that insurance should be central to obtaining routine care, that insurers should have to insure people whose preexisting conditions make them uninsurable by definition, and that present and future generations of federal taxpayers should have to pay for it.

Because congressional Republicans grant these premises, proposals such as the House-approved American Health Care Act and the Senate’s proposed Better Care Reconciliation Act merely adjust the Gordian knot left and right. Policies like these will never untie it. Like Alexander’s men and the ancient beards of Gordia, Congress perpetuates the problem.

The other channel of opinions, the one focused on the solution, resembles the stroke of Alexander’s sword through the knot. It rejects the stillborn premises that the federal government should direct health care policy, that health insurance implies health care access, that the feds should coerce people to buy inefficient products, and that patients will shop around for anything but health care.

Liberty is the only sword sharp enough to slice the Gordian knots of health care policy. For years, the free-market think tank The Heartland Institute has wielded the Consumer Power Report as one such sword, urging lawmakers and other readers to reject government-dictated health care in favor of patient choice.

As of this issue, despite gratitude and appreciation for its readers, Heartland is sheathing the Consumer Power Report, trusting instead in the wisdom and weaponry of liberty-minded warriors among the 50 states and in Washington, DC.

Surely the fight against government-directed health care systems will continue. As all patriots of free-market health care policy know, they who conquer the country’s health care knots will, in many respects, rule America.

— Michael T. Hamilton


Sen. Rand Paul (R-KY) Says GOP Will Vote on Obamacare ‘Repeal and Delay’

Sen. Rand Paul, R-Ky., said Tuesday that Republicans will be pursuing the “repeal and delay” strategy on Obamacare once they vote Tuesday to debate a House-passed healthcare bill.

“This morning, @SenateMajLdr informed me that the plan for today is to take up the 2015 clean repeal bill as I’ve urged,” he said on Twitter. “If that is the plan, I will vote to proceed to have this vote. I also now believe we will be able to defeat the new spending and bailouts.”

On Monday, several senators said they were uncertain which bill would be considered. Paul’s tweet suggests that bill would be the “repeal and delay” strategy that Republicans sent to former President Barack Obama’s desk in 2015, which he vetoed.

The bill, formally called the Obamacare Repeal Reconciliation Act, would repeal Obamacare’s taxes, mandates and spending but leave in place regulations on insurers and give lawmakers two years to come up with a new plan. Conservatives such as Paul favor that route. …

SOURCE: Kimberly Leonard, Washington Examiner

Health Care Price Transparency Faces Opposition in Ohio

Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost is in a state of suspended animation.

One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment.

But the law didn’t go into force on Jan. 1 as scheduled. And its troubled odyssey illustrates the political and business forces opposing a common-sense but controversial solution to rein in high health care costs for patients: Let patients see prices.

Many patient advocates say such transparency would be helpful for patients, allowing them to shop around for some services to hold down out-of-pocket costs, as well adjust their household budgets for upcoming health-related outlays at a time of high-deductible plans.

At the Ohio Statehouse, the law’s greatest champion in state government has been Rep. Jim Butler, a Republican and former Navy fighter pilot whose wife is a physician. He authored the legislation and has beat the drum for it since he got the idea in 2013, as he waited for a garage mechanic to repair his car and absorbed the shop’s posted rates for brake jobs, oil changes and tuneups.

Opposition has been formidable, led by the Ohio Hospital Association. It has filed a court injunction that is currently delaying enactment, peppered local news media with editorials and lobbied Republican Gov. John Kasich. …

SOURCE: Rachel Bluth, Kaiser Health News

Needless Emergency Room Visits Continue to Drive Up Massachusetts’ Costs

Massachusetts has one of the highest rates of residents with health insurance in the nation, but a recent audit revealed that patients continue to turn to emergency rooms for treatment instead of primary care doctors.

About 40 percent of the state’s budget goes towards healthcare, but the state’s healthcare system has significant disparities for low-income and minority residents, according to a report by State Auditor Suzanne Bump.

The audit examines the impact of 2012 health care cost containment legislation.

But five years later, MassHealth costs continue to rise and some residents go to emergency rooms for visits that could have been avoided, according to the report. …

SOURCE: Elisha Machado,

California Prepares to Fight GOP Attempts to Undermine Obamacare

Hell hath no fury like a president scorned. And with the embarrassing collapse of the GOP-controlled Senate’s plan to repeal and replace the Affordable Care Act, many health care experts predict that Donald Trump and his administration will do whatever it takes to “let Obamacare fail,” as the president put it last week.

But the people who run the state’s Obamacare insurance marketplace say they have their own plans in place to make sure hundreds of thousands of Californians don’t lose their health coverage.

“We have pieced together good ideas that have come from health plans and advocates—four or five elements, all about protecting consumers,” said Peter Lee, Covered California’s executive director.

Motivating the effort is this stark reality: Even without Congress’ assent, Trump has a variety of options to obstruct or even undermine the Affordable Care Act.

Among the strategies is a fallback plan in case the Trump administration eliminates the subsidies that help low-income Obamacare enrollees pay for out-of-pocket medical expenses. And should Trump use his executive powers to weaken the enforcement of a critical part of the law—the individual mandate requiring people to have health insurance or pay a steep tax penalty—California could impose its own.

Finally, if Trump curtails the advertising surrounding the upcoming 2018 enrollment season, as his administration did last winter to drive down the number of sign-ups, Covered California can rely on its own robust budget for marketing and outreach efforts. …

SOURCE: Tracy Seipel, The Mercury News