On American Healthcare – A Response to Peter Tutykhin

I am writing to address the response by Peter Tutykhin on August 5th to my article on the current state of the American healthcare system.

First off, I absolutely appreciate that someone who is clearly left of center took the time to read through the article thoroughly, and joined in mostly polite public discourse. It’s not often that you find people willing to do that nowadays. While referring to some of the points I made as “spectacularly absurd”, and the insinuation that my (and many Americans’) stance on this topic is “amoral”, is rather coarse, I will attribute that to his passion for the subject rather than any hostility.

I would recommend Mr. Tutykhin avoid such inflammatory language, if he truly wishes to be part of the solution, as opposed to being a part of the problem that is the volatile arena of political discourse we face in our society. I will move past those comments and try to address Mr. Tutykhin’s responses and explain why a more open and free healthcare system is more effective and morally superior to a nationalized one.

I’d like to start by addressing the idea that I did not engage with the moral side of this argument; this is 100% true. This didn’t come up in my article because I was starting with the knowledge that nothing is free, and that it is immoral to tax the citizenry for non-essential functions of the federal government. Personal property rights and individual freedom are the magnetic north pole to which my moral compass points. “Free healthcare for all” or “Medicare for all” are both infringements on those personal freedoms, as “free” truly means having the program paid for by other people who may or may not want to pay for it. I would include myself in that latter group, and wouldn’t expect anyone to pay for my healthcare either.

Forcing people to pay for the healthcare of others is immoral, and I reject the concept that the government should be in the healthcare business in the first place. With that said, I’d be more than happy if an individual municipality decided to vote for socializing the healthcare in their specific town or city, which is why the concept of federalism is essential. At that point, I would still have the option to not live in that municipality if I didn’t want to participate in that redistributive program. It is immoral to force citizens to partake in something they may not believe in or may not directly benefit from.

As for Mr. Tutykhin’s insistence that I missed the point most progressives make, being that the industry should not be run as a business: I don’t recognize it as a valid part of the discussion due to the simple fact that this country does not run on nationalized industries like socialist countries, but rather on a free market system in which private enterprise and profit is the motive for all business endeavours.

This is a consistent feature of the history of the United States, and nowhere in the Constitution does it say “forget about free enterprise when it comes to healthcare, just make that a nationalized industry run by the government!” and I think that is the case for good reason.

Mr. Tutykhin and I agree that the United States of America has become the “world’s richest country” but rather than being a sign that the U.S. should change its policies to the more socialist and less successful models as Mr. Tutykhin would suggest, I see this as a sign that free enterprise and the emphasis on a profit motive are imperative and should not be tampered with.

The next point I would like to address is the idea that charity is not a viable option in the case of healthcare.

Mr. Tutykhin cited the statistic that charitable donations to healthcare organizations was less than 10% of the federal Medicaid budget in order to suggest that charity alone could not cover the total expense.

I don’t think that can be a fair comparison due to the fact that the $500 billion budget of the Medicaid program comes from those same people who gave to healthcare organizations through charities. That was just the budget of Medicaid, in 2016 Medicare was another $672.1 billion. It seems Mr. Tutykhin is missing the point that those nearly $1.2 trillion don’t appear out of thin air, but rather are being taken from the wallets of every American.

Without the tax burden of Medicare and Medicaid, there’s no telling what amount of that $1.2 trillion would be given to those same charities, or would be used to cover personal medical expenses and private health insurance. All we know is that it would be the right amount, since it would properly reflect the disposable income those Americans are able to part with and the individual priorities of the taxpayer.

https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html

Mr. Tutykhin praised how the NHS helped all UK citizens avoid the need to sell their house to pay for medical expenses and avoid medical bankruptcy. Regardless of however uncommon the problem of medical related foreclosure most likely is (as I couldn’t even find statistics on that problem, just some scattered news stories), this problem would be preferable to some that the NHS has caused. Other than the obvious tax issue, the program also comes at a far worse steep cost.

Just this last year, the NHS in their infinite wisdom forced the families of Alfie Evans and Charlie Gard to keep their ill children in the country and let them “die with dignity”, even though a number of countries offered to try to save the children’s lives. Freedom saves lives. Look at the case of “Baby Oliver” Cameron, who was finally allowed to travel to Boston to seek treatment, and is alive and well. The family successfully crowdfunded the travel costs through GoFundMe.

Both the NHS’s stance on this particular case and Mr. Tutykhin’s stance on the necessity of the use of GoFundME seem inconsistent. With the functionality of the NHS and similar programs essentially being forcibly compelled charity, I don’t see why Mr. Tutykhin would consider people resorting to the voluntary charity of strangers as a “sick joke”. I will acknowledge that the NHS contributed partial funding as well, but I think that should actually count as a demerit on behalf of the NHS in the eyes of progressives, since they should’ve just forced everyone else in the UK to pay for all the expenses. Any system and government under which the parents of an ill child need to ask permission to try to save them is one that I can’t get onboard with.

As for Mr. Tutykhin’s explanation that Medicare is the most popular healthcare plan in the country I say that popularity does not equal competence. Medicare isn’t a sustainable model due to demographic changes, high administrative costs, and ineffective cost control methods. It’s pretty clear to see that tens of millions of Baby Boomers will become eligible for Medicare over the next few decades, meaning that there will be a higher burden put on the taxpayers.

In 1966 there were 4.5 workers per Medicare beneficiary, and it is predicted that by 2030 there will only be 2.3 workers per beneficiary, essentially doubling the cost of the Medicare program on the average taxpayer in less than a hundred years. Many assume that Medicare is more efficient in terms of administrative costs than private insurance due to its low percentage of total expenditure, but this is an inaccurate representation of the costs of the program.

When administrative costs are analyzed on a per beneficiary basis as opposed to as a percentage of total costs, Medicare actually winds up being significantly more expensive than private health insurance. Considering the fact that only tens of millions of Americans are on Medicare, as opposed to the hundreds of millions that are on private health insurance plans the Medicare program is spending a disproportionately high amount on administration a per Medicare beneficiary basis.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2012.pdf

The Center for Medicare and Medicaid Services is so out of touch with the healthcare field that the cost controlling price structure of Medicare Parts A and B isn’t representative of the actual price of procedures in the marketplace. In many cases, this causes some procedures to be conducted where the doctors and hospitals are making less than market value, and some where the doctors and hospitals are making more than market value.

Fixed prices by Medicare have literally no way of always being inline with those of the marketplace since they would be constantly changing, so these price inconsistencies are inevitable with this top-down price structure. So, when the medical institutions are being overpaid for any given procedure, that is an undue burden on the taxpayers.

Also, when the medical institutions are underpaid for certain procedures, either they won’t accept Medicare coverage for those procedures at all, or they will take Medicare and the additional costs the institution is facing will be shifted to non-Medicare patients through higher private health insurance premiums (where participants are already funding Medicaid and Medicare in the first place through taxes). Medicare also has the problem of rampant fraud and abuse, which is such a problem for the program  that there is an easily found guide on the cms.gov website titled “Medicare Fraud & Abuse: Prevention, Detection, and Reporting.” The government even acknowledges that there is “no precise measure of health care fraud” but that it is at a minimum a problem that “[costs] taxpayers billions of dollars”.

A frank admission that this cannot be calculated is an admission that the program is not being managed efficiently and that without proper measurement, management, prevention and waste avoidance become impossible.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fraud_and_abuse.pdf

I would take my “libertarian fantasy” (as Mr. Tutykhin refers to it) over his socialist fantasy any day of the week. Freedom is inherently prone to inequality, and that means that people don’t have a right to take the property of others to try and create a world based on the principle of equality of outcomes. However, people already spend billions giving to charity and would probably spend billions more if their hard earned money was not forcefully taken from them.

If people weren’t so heavily taxed by the government, maybe they wouldn’t even need to rely on charity (voluntary or compelled) and could afford their own medical expenses. When healthcare is taken out of the free market, there is less incentive for innovation and competition, thus leaving an overbearing, out of touch bureaucracy in charge of the healthcare of hundreds of millions of people. All of this is to say, a free and open healthcare market is more effective and morally righteous than a socialized/nationalized one.

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