Now, On Facebook, I know I have a tendency to ramble, follow rabbit trails and tangents, and the like. In my view, so many political and economic issues are linked within the greater philosophy of liberty. One cannot be logically consistent in saying the government has no say in their bedroom or body, then demand government funds pay for healthcare, one policy matter is linked to another, to another, like so many teetering dominoes. But, my point here is specifically healthcare. More specifically, a detailed look at what a true, free market system *could* look like.
I'm not going to rail against Obamacare or GOPcare, those horses are already out on the back 40. This post is for those who would really rather not have D.C. in their doctors office, but, gotta pay those insane medical bills right? Lets look at some options, what could have been, what might be:
What could have been:
Mutual Aid Societies.
Before Medicare, Medicaid, or other government programs, people worked together, voluntarily, to help each other address medical, and other, financial needs. You know those Elk and Moose lodges, among many other diverse groups, they used to serve a far greater function than they do today. They used to be cooperative societies that provided their memberships with various mutual benefits of pooled resources, healthcare, business training and networking, education benefits, financial assistance, and so on. This was community welfare without the state. Some allowed only white men, some only black men, some only women, some men and woman, some along industry lines, or religious lines, these groups were diverse in what they offered members, and what they expected of members. The point here, is many of them offered healthcare affordable access to healthcare. The lodges and societies began to decline in the 1930's, mostly due to increased regulation that favored commercial insurance, and later, public benefits, over "lodge medicine", and licensing boards refusing to approve doctors who accepted "lodge contracts" effectively freezing mutual aid societies out of healthcare in favor of insurance and government programs. Many today would have us believe that without government intervention, our grandparents would die in the streets. History actually shows that, until government interference, our grandparents were pretty adept at handling health costs without government assistance or expensive insurance premiums. In fact, we are where we are today, arguably because of the lobbying of insurance companies for increased regulation against benevolent societies that weren't very good for business. There are actually several banks and insurance companies that began as such societies, and incorporated to continue to exist in spite of federal regulatory pressure against societies in favor of corporate and business entities.
Read More:
Welfare before the Welfare State, The Mises Institute
From Mutual Aid to Welfare State, Heritage Foundation
Mutual Aid is not just Historical, Libertarianism.org
The implication from many often seems to be that without government protection, it is just us, we poor little fish, among the insurance sharks, and only the government can control rising costs. Forget that those rising costs are due to regulations limiting competition, that historical data shows we the people are perfectly capable of affordable healthcare without government strings. This of course, leads to some modern examples of healthcare sharing:
Medical Sharing:
There are several ministries that provide "sharing" of medical expenses among members. They have various levels of coverage, from catastrophic coverage to some that cover preventative checkups and the like. These are ministries that are exempt from the Obamacare insurance mandate, meaning under the law, members are considered to have insurance, although these plans are not themselves insurance in the traditional sense of the word. They tend to be far more affordable than insurance policies, but also limit membership, to some degree or another, along religious lines, the 5 I am aware of all being Christian ministries. I provide their links here purely for informational purposes, without any endorsement towards any given one:
Samaritan Ministries
Christian Healthcare Ministries
Christian Care Ministry
Liberty Healthshare
Altrua Healthshare
Of note, the first 3 on the list have fairly stringent faith requirements, one even needing a pastoral letter to join, as is their prerogative, just something to keep in mind if you're checking them out as an alternative. Liberty seems slightly less stringent, but still requires an overall statement of faith (remember, this is a faith based program after all!) Altrua doesn't require a statement of faith per se, but does require adherence to "moral standards"
I fully support private entities having any entry requirements they wish, and it seems perfectly logical for a share program along religious lines to have faith based standards to some degree. Here's a basic overview of the concept as a whole. I am uncertain of any nonreligious, or even nonchristian, healthshare groups currently in existence, although, to my understanding, the only thing that would preclude such a thing would be current law under Obamacare (the five listed had to be granted specific exemption), I am unsure what impact GOPcare may have here.
It would be interesting to see what possibilities could exist if we combined historical "mutual aid" concepts with these modern health share concepts, perhaps considering other options beyond faith, although faith is a powerful motivator to share needs, other options could include industry groups (Volunteer Firefighter health share anyone? Farmer health share?) The only thing really stopping these options is government regulation and public mentality that it is the government, rather than ourselves, that must fix the issue at hand.
Cost of Medication and lack of competition
Speaking of healthcare costs, an issue often brought up is the out of control cost of medications. Yet many fail to see the irony of seeking government assistance with medication costs, when high costs are often the result of government enforced and protected monopolies. Remember the outcry over $600 epipens? Nobody really seemed to notice that the company that owned the rights to the epipen was able to charge such an outrageous fee because no other company was allowed to market a similar product, until Impax and CVS were able to get a competing generic, and substantially lower priced product, FDA blessed. We often think of the government as protecting us from monopolies and predatory companies, but in the area of pharmaceuticals, the government seems to be a cause, rather than a cure.
Cash based medicine
Speaking of competition, there's a growing trend among some doctors and surgeons, cash based medicine. Many of these providers don't deal with insurance, medicare, or medicaid at all, taking payment directly, and saving substantial money in paperwork and medical billing. Costs are more upfront and clear to consumers, and more affordable and accountable.
Here's an interesting write up in Time about a surgical center in Oklahoma making waves by clearly presenting costs, and substantially reducing costs, showing pretty clearly what free market competition and transparency can offer the industry as a whole. Although the article does fret at the end about being able to pay the cash cost, in most instances I have researched, including the focus of the article, the cost is substantially below other, less transparent options. Here's another article on two other primary care practices who have also moved to cash only, and lowered costs in the process. Combined with vibrant mutual aid or health share options, this indeed makes healthcare quite reasonable without government interference.
Conclusion
My takeaway from what I have seen in my years in EMS, the historical and current data I have seen, and what I have shared above, it is in fact very feasible to have affordable, efficient, effective healthcare if we reduce, rather than increase the role of government and regulation in the process. We could in fact, have incredibly affordable healthcare, through a combination of the above mentioned mutual aid, health share programs, cash based medicine, increased competition and innovation, and overall reducing federal government favoritism and cronyism in the medical and pharmaceutical industries. I welcome your thoughts and input, however, I wanted to share that the libertarian "free market" healthcare response is far from Utopian or a pipe dream. It does exist, it is growing where it is allowed to, it has been incredibly vibrant in the past (of course, with far less technology available). Given the option, I'd much prefer to go to a cash based practice, utilize a health share or a resurrected mutual aid organization for emergencies, and spend less for better care, without any government involvement in my medical care.
