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The Health of the Union Doesn't Include Health Care Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D., The Medicine Men As required by our United States Constitution, the president gave "to the Congress information of the state of the union" on the last day of January. It's a shame that most of the proposals he made were out of bounds according to the 10th amendment to that same Constitution: "The powers not delegated to the United States by the Constitution nor prohibited by it to the States, are reserved to the States respectively, or to the People." Citizens' medical care is not among the powers delegated to the United States government. Our remarkable constitution wisely left that to We, the People. Yet Congress and the president have been abrogating those limitations, with the Supremes endorsing these abrogations, ever since we adopted the constitution. Will Bush try to restore powers reserved to us? Apparently not, at least not for the poor and the elderly, because he says "government has a responsibility to provide health care" to these groups. In practice, this means the government determines how much health care to provide and when, cutting off these classes from medical care beyond what the government considers appropriate and affordable.
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For example, Congress and the president are determined to slow the spending growth rate for Medicare. Current laws require decreasing the dollar amount paid to doctors for their work. As a result, fewer doctors will be able to afford to treat Medicare recipients. Not even government can always force people to do more work for less pay. Although the president says he seeks to "strengthen the doctor-patient relationship," his Drug Enforcement Administration (DEA) treats doctors as if they were drug lords and criminals, creating more suspicion and tension between patients and doctors. Gun-wielding federal prosecutors, in the name of illegal drug enforcement or controlling a so-called epidemic of Medicare "fraud and abuse," are imprisoning innocent doctors for doing the best they can for their patients. Unfortunately, Bush didn't propose reining in capricious and damaging DEA agents and prosecutors which would restore rights of patients and doctors and the doctor-patient relationship. By their fruits, ye shall know them. And these DEA fruits are rotten. (See articles http://www.newsmax.com/archives/articles/2005/1/5/85324.shtml , http://www.newsmax.com/archives/articles/2005/1/19/140320.shtml , http://www.newsmax.com/archives/articles/2004/3/4/94631.shtml )
As now permitted by the HIPAA law of 1996, Big Brother peers over every doctor's shoulder to make sure the doctor doesn't spend government money the "wrong" way. As more and more laws and regulations push costs up, government tries to stanch the spending flow by interpreting its oversight powers ever more stringently and capriciously, further increasing already gargantuan regulatory burdens and fears.
At least Bush did address another area that sours doctor-patient relationships: the lawsuits and excessive jury awards that are forcing doctors to practice more defensive medicine, but only if they can first afford paying liability insurance premiums of hundreds of thousands of dollars in some instances. Bush says, "lawsuits are driving many good doctors out of practice - leaving women in nearly 1,500 American counties without a single OB/GYN."
To curb this distortion of justice, Bush proposes another government intervention - Medical Liability Reform. An accompanying press release claims this latest rescue effort would give us "proven, common-sense reforms that reserve punitive damages for egregious cases where they are justified, limit non-economic damages to reasonable amounts, ensure that old cases cannot be brought to court years after an event, and provide that defendants pay judgments in proportion to their fault."
In addition to tort reform, Bush wants to improve information technology (IT) in the health-care system. Although politicians have never been on the cutting edge of IT, he proposes to provide $100 million to fund projects to harmonize standards and develop models for an Internet-based health information system. Translation: "Harmonize" means "dictate."
Bush sounds more and more like his supposed opponents, the Democrats. He seems to be adopting the "For every problem, I have a program" socialist approach. In addition to the constitutional problem, each program thus created seems to create new problems, resulting in demands for even more programs.
He seems to want to contain health-care costs and increase costs of government.
Bush made several proposals for strengthening health savings accounts (HSAs), which help "individuals and small business employees buy insurance with the same advantages that people working for big businesses now get." This is an important nod in the direction of reducing the "third party" problem or "moral hazard" inherent in insurance. When both the patient and doctor think of the insurance company, the third party, as paying the bill, they both tend to think the lid is off, and spend 50% more than if the patient pays with his own and real money, according to the classic Rand Corporation Health Insurance Experiment http://www.rand.org/pubs/reprints/2005/RP1114.pdf.
More than 3 million Americans have enrolled in HSAs, up from only 1 million a year ago. People with these accounts tend to get away from the world-owes-me-perfect-health entitlement mentality. Many doctors are already aware of HSAs and are providing patients with more information about the medical options available and the costs involved.
I like HSAs and agree with the president when he says the individual should have the same tax treatment as a corporate employee; many of the president's HSA reforms appropriately move in that direction.
But, getting back to the Constitution, a more effective and infinitely simpler approach would be: no tax deductions for health insurance or health care for anyone or any company. The FairTax.org proposal strikes me as an elegant way to accomplish this goal. This would place health care spending on the same footing as spending on all the other goods and services available, including housing, food, and the other goods of this life.
Nothing will cut costs or improve medical care faster and better than letting freedom in by reining government back to within its constitutional limitations.
I look forward to the day when the president has nothing to say about our health care system in his State of the Union address — because government is no longer involved. I can dream, can't I?
Contact Drs. Glueck and Cihak by e-mail.
Editor's note:
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