Last month at Reason.com, libertarian Ronald Bailey published a hypothetical opinion piece from the year 2020 criticizing the effects of 2010’s health care reform effort in the United States. Allow us to retort.
This is a joint response from IEET Executive Director Dr. James Hughes and IEET Managing Director Mike Treder.
Bailey wrote:
With competition all but outlawed, the increasingly consolidated insurance industry has had very little incentive to pay for new treatment regimens outside those specified by government standard-setting agencies.
Hughes and Treder respond:
This just seems like ideological rhetoric with no basis in fact. In what way does the reform legislation “outlaw” competition? The newly created exchanges actually facilitate competition on price, benefits, and quality.
The phrase “government-standard-setting agencies” is a reference to the push for Medicare to refuse reimbursing the cost of treatments that have not been shown to be cost-effective by health outcomes research. But is that not the responsible way for the government to use public dollars? Wouldn’t libertarians be angry if Grandma was getting homeopathy and having it funded by taxpayers? Shouldn’t people have to pay out of their own pockets for wasteful and unnecessary ‘alternative’ medicine?
Bailey:
The negotiation requirement quickly devolved into price controls that have ultimately turned the big drugmakers into little more than cost-plus government contractors.
Hughes and Treder:
(a) Many of the biggest drug makers already are not innovating very much because they prefer instead to squeeze every last penny out of re-patenting slightly improved versions of old drugs. Certainly we need to encourage innovation, but thus far simply offering them a blank check has not produced good results.
(b) We will also note that cost-plus government contractors are able to innovate quite easily in the military-industrial complex. So why not in the pharmaceutical field?
(c) Medical innovation has been globalizing, with many of the most important innovations coming out of the rest of the world, all with universal health care systems unlike the United States.
(d) Explicit government policy can and should incentivize truly important, radical innovations such as anti-aging therapies. In the long run, it will be cost effective—not to mention ethically imperative—and, we expect, will someday soon be considered good politics.
(e) The biggest bottleneck of all in innovation is the underfunding of the FDA and the reliance on corporations to do clinical research. A massive expansion of the FDA, drawing in new scientific expertise for things like tissue engineering and nanotechnology, is called for.
Bailey:
Then there is the doctor dearth.
Hughes and Treder:
In fact there is no agreement in health services research about whether we will face a doctor dearth as a result of this legislation.
(a) We have always had a dearth of primary care doctors in the United States, which is one of the reasons our health care is so expensive. This reform package actually increases reimbursement for primary care doctors to encourage them to choose that specialization.
(b) Advanced practice nurses and physicians assistants are a lot cheaper and do the routine work of doctoring—education, history-taking, monitoring patients—a lot better than doctors. We will only have a doctor dearth if we don’t allow everyone else to use expert systems and provide higher quality care.
(c) Home medical monitoring and diagnostic expert systems will reduce the need for doctors and hospitals.
(d) Healthy longevity will reduce the need for doctors.
(e) We could freeze U.S. physician salaries for a decade and they still would make more than twice what their peers make in other industrialized countries.
Bailey:
Congress changed the law in 2015 on organ donation to a system of presumed consent.
Hughes and Treder:
This really is science fiction. Perhaps they shouldn’t, but 80% of Americans oppose presumed consent and no politicians have seriously proposed adopting it. This is in the league with “death panels” as a Teabagger fantasy.
What we need to do is something every libertarian should appreciate: respect the right of people to donate their organs. If all people with signed organ donor cards had their wished respected, instead of presuming their next-of-kin have a right to overrule them, we could double the supply of usable organs.
Ron Bailey’s critique of U.S. health care reform seems like an impulsive reaction, one that parrots right-wing talking points without thinking through the real implications of the legislation. We’ve seen enough quality writing from him over the years to know he can do better than this.
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