None Dare Call It… | John Goodmans Health Policy Blog |

None Dare Call It… | John Goodmans Health Policy Blog |

But what threatens the foundations of a free society most of all is when it is the government (and its allies in the private sector) who are doing the attacking, and when the reason there is no response is that the victims of the attacks have been threatened and bullied into silence.

I believe that is where we are today ― not just with respect to health insurance, but with respect to health care generally. I’m afraid other industries are not far behind.

During the debate leading up to the passage of the Affordable Care Act, I talked to a number of CEOs of large health insurance companies. I frequently heard such comments as, “Don’t tell anyone I told you this” or, “If you use this information, don’t mention my name” and even, “Don’t tell anyone that we ever had this conversation.”

As far as I can tell, things have gotten worse. In fact I don’t know any employee of any health insurance company that is willing to go on the record with any statement that is critical of the Affordable Care Act.

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4 thoughts on “None Dare Call It… | John Goodmans Health Policy Blog |

  1. The program aside, they have no clue how many people don’t have a computer, are not computer literate or that the cable has been shut off because dad lost his job. And since they have no discretionary money left people cannot afford to buy it even with the subsidy and therefore will be fined for non compliance. The proposed reforms are good in most circumstances but the creators and administrators are out of the loop because they have no idea how many people are out of the loop because of economic disenfranchisement.

  2. Good observation Carl. As Reagan said, and I paraphrase… “The best welfare program is a job”.

    Even beyond the general sluggish economic conditions, there is a more basic issue of how a free society with a representative republic should operate. Robust debate as a catalyst to solve societal problems is essential and it starts with true freedom of the press (referred to as the 4th branch of government by some). Political forces, and their cronies, have hijacked the health care discussion and drowned out those asking the real questions. The constant drumbeat of “health coverage for all” has obscured the better question of “how did we get here in the first place and is more insurance the answer? Maybe, just maybe, too much insurance is part of the problem.” Those who favor centralized control and Single-Payer, are using our present crisis to implicate the free-market; the truth is that there has been no free market forces operational in the health care sector for about 40 years. Herein is poison pill that released its economic slow-death toxin into the health care sector.

  3. Other issues aside, I think the imposition of uniform minimums or basics set by government intrusion into the free market med ins offerings is a positive regulation of the industry. Of course over regulation(esp with small businessman) inhibits growth and weakens sustainable business environment . Seems we continue to be asea in finding policies of mutual balanced integration for government oversight and free market protocols. Seems a true govt hands off economy is not feasible as industry will not self regulate with consumer interests in mind, these being minimized to enhance profit.

  4. Great discussion Carl.

    Under the distorted market paradigm that we live under in health care, I would agree to a large extent with your conclusion. However, in a sane market approach, where the fed government treated people ( and businesses) equally from a tax standpoint, where insurance was truly insurance rather than prepaid health plan, where we had a defined contribution rather than a defined benefit safety net, and where price transparency was the rule instead of the exception then I really don’t think we would need government’s hand in this. In our current system, there is no incentive for the provider/supply side to care about prices and even less incentive to care about satisfaction due to a large captive audience.

    For instance, you mention “uniform minimums or basic set by government”. The irony is, these are in reality the most affordable parts of health care: they are generally preventative in nature, low tech, and readily available which keeps costs down. If the market was allow to function rationally, then these things would be priced according to real costs, not artificially inflated costs associated with third party payment schemes we use now. My point in all this is: we really haven’t had a “healthy” (pardon the descriptor) FREE MARKET in health care for about 40 years.

    Here is a excerpt from an OpEd I wrote in response to a letter to editor about the woes and risks of consumer-driven health care written in JAMA, which speaks to your concern about the industry’s inability to regulate itself.

    The authors allege that “….a consumer-driven model requires, and I quote, “a fundamental reordering of the patient-physician relationship, placing increasing reliance on commercial ethics while eroding professional ethics as a guiding force for patient-physician interactions.” The authors assume that free-market forces will lead to inevitable conflict between commercial and professional “ethics” causing them to become mutually exclusive. On the contrary, in a patient driven model, professional ethics will likely be a more important factor in day-to-day patient care because patients (the consumers in this example) will expect it! The patient’s assumption of ethical behavior by a professional is a huge part of the price we agree to pay and implicit when a professional service is rendered.

    Below are some interesting and insightful posts and articles that speak to the issues you have raised.


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