It's About Control

Government health care initiatives are not about cheaper or better care.  They are about control, and increased power for government officials.

First, via Carpe Diem:

The state is trying to shut down a New York City doctor's ambitious plan to treat uninsured patients for around $1,000 a year. Dr. John Muney (pictured above) offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs. His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.

"I'm trying to help uninsured people here," he said.But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan - which it claims is equivalent to an insurance policy. Muney insists it is not insurance because it doesn't cover anything that he can't do in his offices, like complicated surgery. He points out his offices do not operate 24/7 so they can't function like emergency rooms. The state believes his plan runs afoul of the law because it promises to cover unplanned procedures - like treating a sudden ear infection - under a fixed rate. That's something only a licensed insurance company can do.

"I'm not doing an insurance business," he said. "I'm just providing my services at my place during certain hours." "If they leave me alone, I can serve thousands of patients," he said.

Expect similar efforts by Wal-Mart and CVS to run afoul of the government soon, under some pretext.   Massachusetts debated for over a year before allowing just two licenses for this type of clinic.   I have already observed lefty bloggers turning their nose up at this trend, and sense they are scrounging around for some kind of meme or message to consolidate around to oppose this kind of care.  Because having people find private solutions to their problems is the last thing they want to see.  (Seriously - is this the goofiest indictment of the US medical system you have ever seen? How deep are we reaching here?)
Anyway, should you think I am exaggerating, I will leave you with this story I saw on Radley Balko's site:

The five plaintiffs, who now include former House Majority leader Dick Armey, are challenging a policy of the Department of Health and Human Services (DHHS) that denies Social Security benefits to anybody who refuses to enroll in Medicare.

Read that again: As the policy now stands, if you want to pay for your own health care rather than let taxpayers finance it through Medicare, government will not let you receive the Social Security benefits for which you have spent a lifetime paying taxes.
Note that nobody is trying to avoid contributing to Medicare. The plaintiffs merely want to decline the tax-funded benefits for which they already have paid. None of them want the bureaucracy, the governmental intrusions into their privacy, and the rationing of care they believe Medicare entails - so they volunteer to let taxpayers off the hook by providing their own health care coverage.

But DHHS won't let them. Or at least not if they want to receive Social Security benefits. Forfeit Medicare, says DHHS, and you must also forfeit Social Security even if you've paid for it for half a century.

  • mishu

    Ezra's story is BS. Why would they airlift him to a *small* town in Germany? Why wouldn't it be Franfurt, a major European air hub? With U.S. military presence there, there are plenty of Germans who speak English. I lived just outside of Munich for less than a year and I had no problem finding medical practitioners who spoke English. I was also injured in a small town in Switzerland and found Emergency Room staff that spoke English.

  • http://elambend.com ElamBend

    Soon enough major medical work will be off-shored, either figuratively (imagine clinics just across the border in Mexico) or literally (medical cruises). There are already world class facilities set up in Thailand and other places, staffed with western-trained doctors for just such a clientele. Of course, this will just benefit those who can afford it, the poorer souls who would benefit from the clinics that the government dislikes will be sol.

  • Raven

    AIG was allowed to offer 'insurance products' for mortgage backed securities that it could not possibily fund if the unexpected happened. The fact that AIG offered such insurance lulled other organizations into believing that they had covered themselves in case their risky plays went bad. IOW, a lot of the financial mess could have been avoided if the government had prevented AIG from offering insurance policies that it could not cover.

    Now it may be possible to argue that these clinics have the means to cover the unexpected but there is nothing wrong with governments having regulations designed to protect consumers from ponzi schemes disguised as medicare care plans. More importantly, the onus is on the business operator to demonstrate that they are not creating a ponzi scheme.

  • Bob Smith

    What conceivable Ponzi scheme works like the pre-paid plan described here?

  • Jess

    What mishu said...
    Not too put too fine a point on it, but Ezra's story simply doesn't pass the smell test.
    None of the larger German airports are in "small towns" (there are IIRC, 29 "full sized" airports in Germany, and several of those have only limited service overseas), so how was he flown there? Private/small plane?
    No English @ the hospital? Really? I suffered a minor scrape while in Leipzig a decade ago - every service person spoke functional English (at the clinic - certainly not at my Hotel)...
    Interestingly, they were most solicitous after the found out that I would pay out of pocket, and by being a foreigner w/cash I was billed at a very low rate - less than a local citizen. It was later that I found out why... (if you can't figure that out, well, just wait for free healthcare here - you won't be able to afford it)

    J

  • Methinks

    Raven,

    Ponzi schemes? A doctor performing a service is not a Ponzi scheme. You need to look up what a Ponzi scheme is.

    He doesn't need means to cover the unexpected either. He's offering his services. That's his "means". All he has to do is actually provide the service and if he doesn't, then the wronged party can sue him. No regulators required. Plus, since when is the onus on the business owner to prove he doesn't run a Ponzi scheme? We don't have a presumption of guilt in this country. As a consumer you can have a presumption of guilt, but not as a state regulator.

    Plus, in case you didn't actually read the article...the insurance regulators weren't concerned with his plan per se. They eventually let him run it, but forced him to jack up the price so that he is less competitive with state insurance companies. It's all about reducing the competition for insurance companies, not protecting consumers from anything but lower costs. If the government were in any way concerned about Ponzi schemes it would have shut down social security decades ago.

  • Jeff

    Micro-managing medical practices, over-regulating provisions in health insurance plans, bundling social security and medicare, extending COBRA benefit plans, etc, etc.

    It's all designed to crowd out the private market and eliminate alternatives to universal government health care. Politicians are determined to make medical care so expensive and complicated that nationalizing it will be the only option left.

    I'm sure it will work great! As long as you don't get old or sick...

  • Raven

    I described it a potential ponzi scheme if he was promising services that he could never hope to provide at a profit without endlessing increasing the number of subscribers.

    That said, I don't necessarily believe that this plan is problematic - I just wanted to make the point that the government does have a role when it comes to protecting the public from scams before the victims are created.

  • morganovich

    jeff-

    and this team is at it again. obama has indicated his intention to close the tax "loophole" for charitable giving, but, oddly, only for the rich, who do most of it. the explanations given are so silly as not to warrant discussion. i suspect the real reason is simple: he does not want private competition with his social programs. why else make it harder for individuals to give in support of goals clearly outlined by your administration like feeding homeless, education, health care, etc?

    seems a really ugly (and possibly evil) way to consolidate power.

  • Methinks

    I described it a potential ponzi scheme if he was promising services that he could never hope to provide at a profit without endlessing increasing the number of subscribers.

    1.) Lack of profitability is not an indication of Ponzi schemes and 2.) One more time - the services he promises to provide are his own labour.

    If he doesn't do what is promised, then the government does have a role - to run the court system in which you sue him.

    If you're so stupid that you need government to look over every contract you enter into, then perhaps you should have yourself declared incompetent and allow it to do that for you. I'm not incompetent and I don't think government has a role in making decisions for me. Unless there's reason to believe that he's committing fraud, forcing this doctor to raise his fees protects you from what? Lower costs? Brilliant.

  • Raven

    Methinks,

    The problem with your logic is you are assuming that someone using the service has access to the information required to judge whether he will be able to meet his obligations. This information gap is the reason why the government does have a role levelling the playing field for consumers. Saying that people with limited means should just sue his after the fact does not help because there is no guarantee that the business will be able to pay for any settlement (this is exactly the problem with AIG).

    Now you could argue that the government role should be limited to making sure the consumer has access to the information required to assess the risk and that the information is presented in a way that a non-expert could understand the risk. However, once the government does this it does not make sense for the government to allow a business to run if the risk is large enough that an expert would recommend that a consumer not use the service.

  • Bob Smith

    What an expert would or wouldn't do is irrelevant, because the expert has no way of knowing or applying the knowledge, experience, and values of anybody other than himself.

  • Raven

    Bob,

    So you would be ok with doctors peddling snake oil to people who don't understand the difference between a double blind study and an anecdote?

    It's fine to say that people have to take responsibility for themselves but most people, even if they have the knowledge, don't have the time to thoroughly check out the claims of everyone they buy a product or service from. Telling people to sue after the damage is done is not a practical option and the likely consequence of such a regime is less economic activity because people would avoid risk by refusing to do business with people they don't trust.

    I also don't understand why people are ok with the government passing laws which set the rules for settling law suits but have a problem with the government setting some rules that prevent the need for lawsuit. The latter is often the least costly way of dealing with the problem.

  • Stephen G

    The doctor could simply sell a $5/day plan.

    You prepay for 200 office visits, one for each weekday for the year. If you don't visit taht day, you forfeit your right to that visit. Evrey visit can include a same-day return, no additional charge.

    Problem solved.

  • Ool

    > Ezra’s story is BS. Why would they airlift him to a *small* town in Germany?

    Because room and board are cheaper? After all, this is about saving the insurance money, isn’t it? Because the places where US military are stationed isn’t near any metropolitan municipal hubs. (At least around here in Grafenwöhr they’re definitely not, and Ramstein/Landstuhl isn’t exactly Manhattan, either.)

    So I can think of a few reasons…

  • Ool

    > The doctor could simply sell a $5/day plan.
    > […]
    > Problem solved.

    Yeah, except that you’d be married to a single doctor’s practice, as opposed to a government-regulated single payer health insurance plan, which lets you go to any general practitioner in town that you like for just €10 any quarter year that you need one.

    But I suppose that this is evil and socialist. Woe is me; I suffer under the yoke of a totalitarian dictatorship over here…