Access, Access, Access

“Access, Access, Access” Rick Perry repeated to Bret Baier. It seemed a grilled candidate’s non sequitur to Baier’s question: weren’t many Texans uninsured? But I was struck by its truth. Insurance is of little use if no doctors take it, no medicine is available, deductibles and premiums are unmanageable. Positive rights – to food, to medicine, to jobs – are not rights. The theory never stands up to experience.

Perry’s run was brief; now, his task is encouraging access to energy – of all kinds. Trump seemed an example of excess – still is, I guess. But a nation not just energy independent but energy dominant is one empowered, free. And we can free others: a Europe not beholden to Russian oil is a healthier Europe. Neither Trump nor Perry invented fracking nor could Obama stop its success. But this administration respects it, clears the way for its natural flow.

Access, access, access – how much does access to energy change our lives each day? How many are alive today because of access to energy forms unknown or at least unused 300 years ago? (Without air conditioning, I would have left my husband years ago. Then, again, he might have come with me.) Consider, though, the other extreme: we would be shocked to hear of elderly couples found frozen in the depth of winter, not uncommon in other times and places. How much more food is generated because of cheap energy? How broadly is food distributed?

We know the maxims often forgotten by our betters in Washington:
1) If you want cheap prices, produce more; if you want high prices, limit production.
2) If you want cheap prices, free the market; if you want high prices (or less access if prices are subsidized) give the government control.

Access drives down costs, goads the health profession to better service. More doctors, more clinics, more devices, and more engagement with patients’ needs: in short, access creates a more effective, altruistic perspective in the provider and a more responsible one in the consumer of health services.

As we learned in south Texas, access happens when external burdens are lifted. Not buried by malpractice insurance, doctors returned and access increased. Any entrepreneur takes risks. A government lean, fair, protective of private property and contracts will not ensure success but offers some predictability. Crony capitalism and graft are lead and fog to an entrepreneur, expense and shoddy merchandise to a consumer. Access disappeared in the VA hospital scandal, but that is not surprising. Rationing (and shoddiness), graft and corruption accompany an overbearing state.

While the opponents of the Republican health bill are many (and the Republicans hardly united), discussions by its proponents also often miss the point of why Americans objected to Obamacare and why it was not a good fit for us – with our traditions, our beliefs and our understanding of human nature.

I’m no expert in business, insurance, medicine, or governmental policy, but I feel gratitude for the benefits of the last centuries, ones that came from the openness of markets, the scientific method, cheap energy. These benefits paralleled America’s growth from a few states hugging the eastern shore to an important power that lent its power thrice in the twentieth century to aid Europe.

And, as a consumer who lived through a chunk of the last century, I’m stunned we haven’t all learned from the good examples as well as the bad. When Warren and then Sanders declared that we need a one-payer system, Republicans in Congress should have felt a chill up their spines – and, reminded of the alternative, bent to work.

So should voters. Certainly I felt that chill. Little in the pipeline will extend my life. But a healthier, free market medical system is likely to improve the lives of my children and grandchildren. Nor do I want the government making decisions for them, life and death decisions, that should be theirs.

Access: to medicine, markets, communication. The “can do” spirit matched with the test of whether it works or not underlies those three centuries. However, in the last decade, longevity decreased for some major cohorts – an unusual trajectory. Most see the causes as cultural. But part of that culture is an Obama perspective and Obama bureaucracy. Certainly, it says little good about Obamacare that those were its years. (Nonetheless, the Democrats, projecting, argue it is Republicans who want people to die.)

Bureaucrats and progressives posit a perfect, frustrating the doable better, and end up with the worse. Change stops. Curiosity is stifled, life is deadened.

Congress may not open a totally free market, but we know what works and what doesn’t. We should begin that understanding.

12 thoughts on “Access, Access, Access”

  1. Well said. We are about to get a fresh object lesson as California stands on the threshold of enacting a state single payer health care system that entitles illegal immigrants as well. Will Brown veto it? Right.


  2. Thanks Death 6
    David: a few years ago I was talking to a colleague – career military, teaching as second career – and said something about killing the men and kidnapping the women. He argued that in the past (pre-machines) that it was expensive to kill the men who could better be worked (as slaves and perhaps to death). I assume that varied – in subsistence cultures they may have been another mouth to feed, in imperial ones they could, well, build pyramids and aquaducts because they were two hands. I don’t know if that is true.

  3. Market cash medical systems are coming, probably regardless of what Congress does.

    Obamacare destroyed the old system.

    The hospital where I practiced for 30 years and organized a trauma center, which probably kept it open, I would not admit a member of my family to today,

    It is owned by an order of nuns who hired a Pepsicola executive to be CEO. He hired his brother in law, a chiropractor, to run the operating room.

    The hospital bought all the doctor practices on the theory that Obama care would be a bonanza for hospitals.

    My former surgical group, which had run the trauma center for 35 years,. was made “an offer they couldn’t refuse” to buy the surgical practice. They said “No thanks.”

    The group was fired from the trauma center when the next contract renewal came due and a group of female surgeons that were from somewhere else and who no one knew, were hired to replace them.

    The ER docs were told not to refer to the old group and the internal medical group, which is now owned by the hospital, was told the same thing.

    I understand there have been serious problems with trauma cases but no one is talking.

    Doctors who I know and who have been on the staff for 35 years are no longer allowed to admit patients to the hospital. They have to be sent to the ER where hospital employee ER docs will decide if they should be admitted.

    Medicare patients who are admitted are required to make a $500 “donation” to the hospital to be admitted.

    The Joint Commission shut down elective surgery the summer of 2015 because of excessive infections and operating room cleanliness problems.

    It will be hard to undo a lot of what Obamacare did.

  4. “Isn’t this illegal?”

    It’s “voluntary” I suppose you could refuse but most people being admitted to the hospital would be reluctant to do so. My wife was admitted three times in two years with pneumonia. Each time she (we) had to pay the “donation.”

    She is on a new biological drug ($7000 a month but mostly paid by a foundation related to the developer) which has made a huge improvement. She has not been seriously ill in two years. She has COPD. The new drug is injectable every three weeks.

    We have since moved to Arizona and the climate, hot as it is, should improve things even over California. She was referred by her allergist to an excellent allergist he knew in Tucson and she gets the same drug with less hassle here. The outpatient surgery suite at Mission were charging her $150 per session in addition to Medicare.

    I think a lot of hospitals that bet heavily on Obamacare, by buying up all the medical practices to establish a vertical system, will be in big trouble with a free market system, which I hope Congress moves toward.

  5. ” He recent;y went “concierge” – $2000/year. I’d say he is well worth it.”

    I expected to have to find a “concierge” internist but, so far, seem to have lucked out.

    My impression was that there was more of this in Tucson but so far it seems I was wrong.

    Cash practice is much cheaper as the transactions costs of insurance are high, mostly about 50% of the revenue.

    Pediatricians have the highest overhead and are the worst paid.

    If we really went to free market, cash medical practice doctor’s incomes would take a small hit as patients negotiated fees.

    We are already far down that path as Obamacare has resulted in bifurcation of internist’s practices into pure office and “hospitalist.”

    The hospitalists I have encountered recently seem poor trained and are probably poorly paid as the hospital has them by the short hairs.

    The system we should evolve to is cash for outpatient and insurance for inpatient. The poor and pre-existing conditions should go to a form of Medicaid.

  6. That graph, which I agree with, has nothing to do with “free market capitalism.” Unbridled or not.

  7. I’ve seen similar graphs for colleges.

    Such graphs signal both institutions have had increasing government funding and oversight, are industries controlled by the government if not owned by it. That is not free market.

    This trend also lays waste human capital and human sympathy by violating the maxims of subsidiarity. (I keep forgetting that word, I guess because it was a late addition to my now depleting vocabulary – but it remains a glistening concept.)

    Yesterday my husband got a phone call from one of his best grad students; he had graduated and been teaching at a small Catholic college. Part of his news was that the school is downsizing (and he has prospective work but will no longer be there). And our doctors are all part of a large, generally helpful but completely bureaucratic system. We no longer can phone a doctor’s office, talk to a knowledgeable nurse or perhaps the doctor – it all goes through a switchboard for the hundreds that are a part of that system.

    Changed institutions (and of course automated driving) will make the next decades risky, perhaps exciting, and not always comfortable.
    7/6 – N Review: Obamacare & Lives Not Saved

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