Michael Arnold Glueck and Robert J. Cihak
Wednesday, Nov. 19, 2003

Michael Arnold Glueck wrote this week's column.

It's always something with medicine! The column de jour for many op-ed writers this week is the crisis of the prescription drug plan – a benefit or entitlement, depending on which side of the aisle you sit on!

In American politics, nothing matters unless it's defined as a "crisis." That's one reason why we have the same crises decade after decade.

In medicine, however, "crisis" has a more specific meaning. It's the moment when you either die or begin to recover.

Today, American health care is in both kinds of crisis.

It's been in crisis since the 1950s, when proponents of state medicine suddenly discovered that the elderly weren't all that happy with their coverage.

It's been in crisis since the 1960s, when LBJ, Congressman Wilbur Mills (then chair of the House Ways and Means Committee) and what is euphemistically known within the Beltway as the "benefits community" created a Medicare they knew could not be sustained long-term ... and threw in Medicaid for good measure.

It's been in crisis since the 1970s, when the HMO Act established a "managed care" system in which the only way to make money was to sell group coverage to employers, then withhold care.

It's been in crisis since the 1980s, when employers noticed that the cost of insurance had gone bonkers and reacted accordingly.

It's been in crisis since the 1990s, when Hillary tried to take over one-seventh of the entire economy ... and when trial lawyers conceived that medicine might be improved by a "Patient's Bill of Rights"-generated mass infusions of lawsuits.

And it's in crisis today, as Congress and the administration prepare to tack onto Medicare a prescription drug "benefit," offering as partial justification the fact that, since Medicare will inevitably go broke with or without it, why not just do it now and worry later?

But America's health care system is also in acute crisis. For this is the moment when the system either dies or changes. Continue along the present path, and within a few more years we will have state medicine. (And doubt not that this is the goal of those who have willfully wrecked the system to justify governmental takeover.)

Or we can create, for the first time, a genuinely free market in health care, based upon the astonishing principle that the American people are capable of figuring out what they need and then finding it.

What a System Based on Freedom Might Look Like

It would, first of all, restore the clear distinction between insurance and payment for services. By definition, insurance is the pooling of risk against infrequent but nonetheless predictable events. In medical terms, this means hedging against physically and financially catastrophic events. Payment for services means taking care of more routine, although far from inexpensive, matters.

Catastrophic health insurance should be available to all, whether through employment, through groups formed for the purpose of purchase, or through purchase from the federal or state government. As a matter of decency and humanity (not of right), such insurance should be made available at reduced rates, or simply given, to the poor.

As for the services half, three principles apply.

First, people should be free to purchase only what they need. Why pay for other people's pregnancies or abortions if you're a man, or a woman who won't be getting pregnant? (Imagine how wonderful it would be if the cable company sold only the channels you wanted, not the entire package.)

Second, people should be free to form purchasing groups, and organizations should be free to offer specialized services. We're already seeing specialized offerings, such as dental or optometric, coming out of groups such as AARP.

Cash also has its place. For example, a Seattle group, SimpleCare, offers routine services at substantial discount if a patient pays cash – a discount made possible by the clinic's substantially reduced paperwork and administrative costs.

Barter might also find a place. And governments at all levels, again as a matter of humanity and decency, should provide routine services to the poor.

Finally, the government should encourage the creation of a freedom-based system through expansion of tax-exempt or deferred medical savings accounts and other tools.

All very fine ... especially if you believe that the American people are more than a bunch of lazy idiots who want everything handed to them by the federales. But what reason is there to believe that this is the moment of acute crisis?

The American economy is structurally unsound. The proliferation of debt at all levels of government and the private sector, the hemorrhage of jobs, the trillions now required for homeland defense and foreign adventures, the aging of the workforce – a dozen reasons more might be adduced. Wrecking one-seventh of the economy, turning it from private profit to government liability, could well be the straw that does the deed.

Let us be honest: The patient in crisis nowadays is America.

Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a past president of the Association of American Physicians and Surgeons.

Contact Drs. Glueck and Cihak by e-mail.

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