Monday, August 17, 2009

Health Care Cost Containment

Institutions have lost flexibility, the ability to adapt to changing conditions. The loss of flexibility comes from rules, laws, policies, taxes and regulation. The purposes of these phenomena vary, but range from addressing public health issues to increasing revenue to policing moral failings expressed in destructive business tactics.

The issues of human fragility, a lack of moral attentiveness, or a combative competitive urge towards anarchy has been dealt with by the creation of governments. A government is created at a point in time from then forward must use the system to meet new situations. The familiar situation will be the most easily solvable and the new variant situations will demand creativity and flexibility in order to survive the new conditions. Maintaining moral values must be imperative as the system morphs enough to meet changing conditions.

As a moral imperative to be honest and trustworthy apparently will not define the current moral atmosphere that if it is not defined as illegal then it is all right to proceed, no matter what earlier moral codes would have prohibited such action on the basis of good or evil. This malfunction of the economic system is a demonstration of a lack of adaptation to changing conditions and a failure of moral predictability. An economic system that is posited on the rule of law, growth and cheap resources worked well in the conditions of Manifest Destiny but may not function so well under population and resource buildout conditions.

The basic tenets of free enterprise were developed under frontier expansionism but were soon diluted by regulations within communities. Free enterprise is exactly that: an individual will have freedom to open a business using their property for that business, barring some public health concerns. Commercial areas are now long distances from the clients, must maintain huge parking lots and must pay exorbitant rent, pay higher taxes and buy insurance for employees. The small entrepreneur working out of a home is priced out of the market due to the money siphon to government assisted by big business. The recent economic downturn has closed down businesses, the city and county are raising taxes and the unemployment level is climbing. The system is so tied up in revenue enhancement, gigantic loan payments, fees and high taxes, all flexibility is lost.

The subprime scandal is an example of maladaptive behavior that some would view as criminal, as that self serving cynicism appeared to rule human behavior, rather than a well considered morality aimed at the good of society. Some confuse free enterprise with a free for all attitude resulting in personal gain without consideration of the peripheral damage. Free enterprise must have rules like chess in order to function. Eliminating competition through buying politicians to install high government fees and taxes on small businesses is not free enterprise. Competing should be based on quality service and quality goods, not manipulating the environment so no others exist. The current economic environment is regulated into sluggishness and rising unemployment, amid the crisis of confidence created by the subprime scandal.

The fewer choices people have, the less free enterprise functions. Government ordered expenditures from the earnings of citizens in the form of mandatory insurance results in price fixing and high prices plus an unwelcome power grab on the part of those anointed to sell this mandatory insurance that can be cancelled with no refund for you. Forcing citizens to buy insurance will tie up more money into the hands of a few.

So what kind of system do we here have? Private profit and subsidized losses for the financials immersed in the subprime morass? That did not please many citizens, whose losses were ignored as the ‘investments’ went under with the money long gone. The bailouts were disliked and resented at the grassroots as the scandal continued in bonus payments promised through the implementation of a business model that was aimed at selling specific debt derivatives to unwary investors, a goal that had nothing to do with the public good, only a short term profit for a few. And now taxpayer money subsidizes these people as they collect high salaries and ‘bonuses’ earned by bankrupting the company. Of course more regulation became reality as a result of this lack of social responsibility. So we have a system that takes from the taxpayer to give to the financials and insurance companies while also forcing the citizenry to buy services from insurance companies, entrusting them to make payments to our health care providers. We subsidize private sector insurance middlemen as required by law.

Using private enterprise to enforce public policy is contrary to the system of free enterprise. The government should not mandate that the citizenry buy from private enterprise or government. If private enterprise needs more clients, the services they are selling should be competitive, not mandated by the government. Free enterprise begins with the consumer and discretionary income and free choice to buy or not to buy. Free enterprise depends on the consumer having freedom of choice to patronize any given business. If discretionary income is so allotted to mandatory programs, fees and taxes, free enterprise suffers.

So are we a free enterprise society or not? The current health insurance debate seems to leave personal choice out of the picture. Bureaucrats and insurance executives have created a system that requires an ever larger percent of the income in order to function, a trend that is obviously unsustainable. Healthcare costs need to be lowered, tort reform accomplished, and voluntary individual insurance must be instituted in order to give the free enterprise system room to function. Competition among insurance companies for business from a captive audience is not to be confused with competition for individual patronage by a legitimate business serving the needs of the people. Let the healthcare providers compete for the peoples’ business by lowering prices. Allow the money to pay for healthcare to remain in the hands of the people and let the insurance companies and government compete for this business. The costs of health insurance and health care will be more affordable because competition and flexibility will be reinstituted into the system.