Free Market in Health Care
Report by Betty Sakai
Executive Director of the Benjamin Rush Institute in Half Moon Bay, CA, Dr. Beth Haynes discussed the work of the Institute, to work with medical students and professionals, to protect the doctor-patient relationship, to preserve healthcare freedom. She confided she went into medicine to help people, that doctors go into medicine to help people. She quit practicing medicine 15 years ago because good medicine requires freedom. Increasing government regulations were making it more and more difficult to practice good medicine.
The liberal mind fears the free market but in truth a free market has never existed in medicine. Government has been involved in medicine messing it up for over 100 years. Many equate the free market with uncontrolled costs and demand government control the industry to prevent anyone from being left out on the street without affordable care. The problem is one of being informed, staying objective, and remaining rational.
Dr. Beth Haynes lobbied against the passage of the Affordable Care Act (ACA). She then decided to focus her efforts nationally. She accepted an offer about five years ago from Sally Pipes, author of The Pipes Plan, The Top Ten Ways to Dismantle and Replace Obamacare (Regnery Publishing, 2012, www.regnery.com). Dr. Haynes became the Executive Director of the Benjamin Rush Institute in Half Moon Bay, California. Sally Pipes is Chairman of the Board of Directors of the Benjamin Rush Institute [a 501c3 organization] and President and Chief Executive Officer of the Pacific Research Institute. As a point of reference, Beth compared the Benjamin Rush Institute to the Federalist Society. Her mission as Executive Director is to bring national attention to the replacement of the ACA, and to help medical students and professionals understand what a free market in medicine is, what good medicine is. The Institute provides seminars and classes to give medical students free market knowledge by which they can re-educate liberal institutions and professors about alternatives to the ACA.
The fact is, medical students rarely receive free market concepts. The majority of medical schools focus on government-controlled socialized medicine. In seminars, students are asked questions about ethics. To whom does the physician owe their allegiance? Do they owe their allegiance to an insurance company, to government, or to the patient? A few professors favor the free market but don’t speak out because they fear losing their research funding if they oppose the ACA. One student was publically shamed for asking whether Medicaid can provide quality care. A 2012 survey of medical students found that 80% were in favor of the ACA, 50% questioned the quality of care ACA produces, and 47% did not even know what it is.
Alternatives to the ACA exist. Direct primary care is one type, providing a membership agreement between the patient and clinic or doctor. With direct primary care, insurance is not normally a factor. Concierge medicine is another type of direct primary care but insurance is billed.
Few people understand how government regulations affect physicians. Doctors are in crisis. Morale is low. 75% of physicians today are employed by large groups or hospitals. This is by ACA design. Physicians are forced to practice in large groups to curtail costs. Government mandates and regulations suck the soul out of physicians who are being told how much time they can spend with each patient, are faced with financial penalties if they do not input patient data into exorbitantly expensive software providing sensitive patient data to government. The code of ethics is being changed from centering on the patient to social justice, a responsibility to more than to just the patient. Over 50% of a doctor’s time is being used on paperwork or to input patent data. While primary care doctors like the in-house electronic records they designed for their practice, other physicians do not. But with the ACA, all doctors are required to input patient data. In 2016 a Physicians Foundation survey shows that 54% of doctors feel somewhat negative about their profession, 49% feel burned-out, 49% would not recommend the profession to their children, 80% feel at capacity or over-extended, only 14% feel they have enough time with patients, and 48% are seeking to cut their hours to work in something non-clinical. The crisis has caused the loss of 200 to 400 physicians every year to suicide!
A doctor is a person who does not enter the workforce until they are about 35 years old. They leave medical school shouldering an average debt of $170K. Many shoulder a larger debt (some schools charge $30K to $70K per year for tuition). Young doctors find it difficult if not impossible to go into private practice. A doctor cannot buy a practice and pay off tuition debt plus face expensive mandates from government. Today’s doctors are saying they want out of the doctor-mills.
Dr. Haynes discussed the opportunity we have now with a new administration to make changes. She noted that more progress can be made in the regulatory area than in legislation. The ACA requirement that health insurance cover all pre-existing conditions is making insurance unaffordable. We need to ask what we expect insurance to do. Do we want insurance to cover everything? Can primary care be made the most cost-effective using the free market? We want insurance to cover the unaffordable expenses.
Of course, there will always be those who are disabled and those who cannot afford even properly priced free market primary care. In California 33% of the population is on Medicaid. 50% of all births are paid for by Medicaid. This is not an insurance issue but a problem with a distorted pricing structure. Comprehensive medical insurance is very expensive.
Noting that insurance provided by an employer does not belong to the employee, by not following the employee after they leave employment, this is a factor in creating pre-existing conditions. Also, tax equality for all health care expenditures would take a lot of the distortions out of the market. By allowing physicians to compete, they will come up with cost-effective programs that will bring down the costs of hospitalization.
Dr. Haynes commented, “One such program that exists, the Surgery Center of Oklahoma, which is not a hospital but an ambulatory surgery center. This is a business that offers prices for out-patient surgeries which are posted online. They do not accept government money nor contract with insurance companies – and their prices are 1/6 to 1/10th of standard hospitals. Because of this, they frequently get patients [who] travel from out of state, or even from other countries to take advantage of their high quality, low-priced care.”
In the Q & A session, Dr. Haynes was asked about how free market principals apply to Medicare. She answered that most folks like Medicare. Most feel Medicare is pretty wonderful … and are oblivious of the cost to their grandchildren. She said, she would recommend defined contribution rather than defined benefit so that there is a floor under which nobody is allowed to fall. If you want something more than that, you have to pay for it.
Asked about local physicians that have direct care plans, she gave as examples Dr. Lorraine Page in Half-Moon Bay, a clinic called One Medical, and Dr. Cobb in San Francisco, and referred inquirers to a website called The Wedge: www.cchfreedom.org/cchf.php/1192 created by the Citizens Council for Healthcare Freedom, listing physicians who are 3rd party free.
Asked why doctors did not stop the ACA, Dr. Haynes answered that most doctors are not lawyers. They are smart but are also conflict and controversy adverse. It’s taken a while for physicians to experience the ACA. Asked if doctors should be made to ask and report to the government if guns are in the home, Dr. Haynes said no. The relationship between a patient and their doctor should be solely between the patient and the doctor.
Asked about how the hodge-podge of medical malpractice insurance affects healthcare reform, she said it contributes but malpractice is a state issue, not a federal issue. Within the scope of things, if there was a functioning free market price system, liability issues and defensive medicine should play less significant roles. Of course, because malpractice attorneys are connected with malpractice insurance, cronyism will always exist and malpractice lawsuits will always happen.
As a member of Docs 4 Patient Care, a free market 501c6 physician membership organization originally formed to oppose the AMA’s backing of the ACA, Dr. Haynes said the group later changed into a D4PC Foundation, a 501 c3 educational think tank for health policy, created and run by practicing physicians.
Besides working with medical student programs at such schools as Ohio State, at Duke University, and at the University of Cincinnati, Dr. Haynes emphasized the need to educate and influence the general public to understand and not be afraid of the free market providing the delivery system for their health care. The Conservative Forum applauded Dr. Beth Haynes presentation. She had provided excellent insights into the Affordable Care Act and into changing it.
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