Libertarian Party has begun its campaign and hopes you will listen to their plan for healthcare.  So here is their plan – and a few stark realities.

The Libertarian Party  would remove government from all health care. No Medicare no Medicaid (or AHCCCS) no mandates. It would be “open market” and let the marketplace rule for healthcare.

Their view is based on the strong belief that the marketplace will cure the rising cost of healthcare. Libertarians believe the reason that healthcare costs are higher is because of government intervention.

Their view of the rosy 1960’s was that “low-cost health insurance was available to virtually everyone – including people with existing medical problems.”

The first part of their premise is simply untrue. Low-cost health insurance was an employer generated benefit, and available to those who were in the workplace, and not those who were out of work by retirement, unemployment, or disability. In fact “And what they had was terrible insurance — it didn’t do much to cover them,” said Dorothy Pechman Rice, a retired professor at the University of California at San Francisco who served as director of the National Center for Health Statistics from 1976 to 1982.

“…in the early 1960s, the choices for uninsured elderly patients needing hospital service were to spend their savings, rely on funding from their children, seek welfare (and the social stigma this carried), hope for charity from the hospitals or avoid care altogether.” – Rosemary Stevens, University of Pennsylvania.

What they did have were charity hospitals where you could go if you had to. Today’s Maricopa County Hospital is one of the few that remains, as most have gone (Charity Hospital in New Orleans) or morphed into modern hospitals taking insurance like Cook County Hospital in Chicago. What happens when people need charity vs. government spending? Without government intervention, the building of the hospitals and expansion of coverage – people would have died sooner. 

But consider this – in the 1960’s you didn’t have cancer chemotherapy, you didn’t have radiation therapy, you didn’t have coronary artery bypass, you didn’t have angioplasty, antibiotics were limited to a few, there was no laparoscopic surgery, there was no organized trauma system, the first pacemaker had just been implanted in Sweden. There were no drugs for heartburn and if you had a bleeding ulcer there was no endoscopy, just surgery.

There are reasons healthcare was less expensive in the 1960’s. There were no drugs for high cholesterol, and there were few drugs available for high blood pressure. One of the few drugs that became available was propranolol – which the Libertarian party claims the FDA kept from people:

“We should replace harmful government agencies like the Food & Drug Administration (FDA) with more agile, free-market alternatives. The mission of the FDA is to protect us from unsafe medicines. In fact, the FDA has driven up healthcare costs and deprived millions of Americans of much-needed treatments. For example, during a 10-year delay in approving Propranolol (a heart medication for treating angina and hypertension), approximately 100,000 people died who could have been treated with this lifesaving drug. Bureaucratic roadblocks kill sick Americans.” 

Their statement about propanol is simply untrue. It was developed in 1964 and marketed in 1965 under the name Inderal.  The FDA has not driven up the costs of medicines, consider that almost 25% of the cost of new medicine comes from direct-to-consumer marketing in the United States. It is the free-market that is increasing the cost of medicine, not the FDA.

There were to CAT scans, no MRI, no ultrasound scans. Operating rooms were minimal and had higher infection rates, higher rates of post operative deaths.

When you look at those advancements – the vast majority from government funding through the NIH or other agencies. The same agencies  the Libertarian Party wishes to defund.

With medical advancement came costs and something the Libertarian party has refused to acknowledge, much like advancement in other fields, it comes with increasing costs.

Libertarians do not recognize that the cost of healthcare is actually less per person when the government funds healthcare.  In other Western Countries (where government pays more) the cost per person of healthcare is less.  Even the out of pocket expenses are less.  In France the out-of-pocket expense is $305 per year while in the United States it is over $2000 per year.

Even in Singapore, the place Libertarians often cite as an answer to healthcare, the government funds a vast majority of healthcare. In Singapore the acute care is 80% financed by the government. In contrast the United States funds 64% of healthcare.

Medical Savings Accounts

A novel idea, but it is simply another name for a higher deductible. Instead of the deductibles being a few thousand dollars, they would be upward of ten to twenty to thirty thousand dollars.  What happens when that runs out? Is that it, everything else is covered? No answer to this one, but the way most insurance companies work, it would be per year.

Charlie worked in the insurance industry, had the best healthcare money could buy. Then he developed a brain tumor. He ran through his lifetime benefit of coverage (which has been lifted because of the Affordable Health Care Act that the GOP and Libertarians wish to repeal).  He spent another million dollars of his own savings for his healthcare before the brain tumor took his young life. He could afford that — could you?

One patient who comes in for a routine operation and has a complication can spend a million dollars for a few days in the Intensive Care Unit. Would the catastrophic insurance take care of the rest of that, or would they deem this is uncovered because it was not a catastrophic event?

The Golden Era That Wasn’t

Do you want to go back to that era of the 1960’s, because I am certain an insurance company would be happy to sell you a policy where they only had to provide medicine circa 1965. Of course even then most people went through savings when an illness hit.

Yes there are some government mandates that are silly.  When a state government mandates insurance companies cover chiropractic or acupuncture when the scientific evidence is opposed to it. But those mandates cost little.

But when it comes to healthcare reform it has been the involvement of government that has expanded the reach of healthcare for all, decreased the rate of bankruptcy secondary to healthcare by expanding its reach, and provided standards for healthcare. The more government has been involved in healthcare the longer the lifespan has become and less infant mortality.

Or you could go back to the 1960’s – with fewer drugs, fewer treatments of disease, and cheaper healthcare.