We just summarized the likely outcomes of Free Market reforms. The blessings of such reforms need not be debated as they are obvious to any reader. True free market reform brings about the desired outcome and blesses everyone. If the blessings are so obvious, why then is this not the direction our government is taking us in?
The answer? Because of politics, self interest, a fear of losing power and a belief that the status quo will continue to work in the future as it has “worked” in the past. The answer lies in a compromise among all of these forces represented by the different lobbying bodies in Washington. I am well acquainted with many of them.
These lobbying forces are many and strong. To name a few, they are:
1. The Insurance Industry
2. The Corporate Lobby
3. The Insurance Broker Lobby
4. The Media
5. Politicians
6. Unions
7. The Socialist Movement
8. Doctors & Providers
9. Individual Citizens
By looking at each one of these players you will get a sense for the reforms that will actually come out of Washington and why. I will briefly touch on each one of these.
The Insurance Industry
The insurance industry will obviously fight against several things:
1. Ending their exemption from the Sherman Anti-Trust Act
2. A Public option that would compete with them
3. Opening up competition against co-ops & health shares
4. Opening up competition of insurance companies across state lines
5. The end of the employer sponsored health plan
6. Opening up the exchange to those who already have insurance
7. Cap out-of-pocket maximums
8. Pre-existing condition reform
They will fight for:
1. A mandate that says everyone should have insurance – even at the expense of businesses
2. Tools that allow them to negotiate down prices
3. An exchange that makes it easier for people to buy their insurance who didn’t already have it
The Corporate Lobby
The Corporate Lobby will obviously fight against several things:
1. A mandate requiring them to “pay or play”
2. Repealing the tax deduction on contributions to employer sponsored health plans
3. Not allowing them to participate in the health care exchange
4. Taxation on “Cadillac Plans”
They will fight for the following:
1. Small business exemption to any mandates
2. Credits that make it easier for them to provide health care
3. An open health care exchange
The Insurance Broker Lobby
This lobby will fight against:
1. The end of the employer sponsored health plan
2. Any kind of tax increase on employers
3. Anything that damages the insurance industry
Reforms they will fight for:
1. Reform that would bring more people onto employer sponsored health plans
The Media
I don’t believe they will “fight” against anything. Although they may not cover, or give air time to important reforms such as:
1. Elimination of the anti-trust exemption for insurance companies (they support the media through advertising)
2. In depth coverage of free-market reform
Reforms that most of the media will fight for:
1. A Public Option – within 45 minutes the other day I saw “How American Healthcare killed my Grandfather” and Bill Maher accusing America as being the only developed nation that “get’s rich on people’s misfortunes.”
2. Coverage for everyone
Politicians
Reforms they will fight against:
1. The overt end of the employer sponsored health plan
· Why would they not fight for this? It is because it goes hand in hand with Medicare and Medicaid. Medicare exists only because of the dominance of employer sponsored health plans because most employers don’t insure people after they retire. Therefore, the government can do that instead. Furthermore, Medicaid also exists primarily because of the employer sponsored health plan because employers don’t insure the unemployed or non-working class. Therefore, the government has a program to take care of them too. These are two programs built around employer sponsored health care. By eliminating the employer sponsored health plan and creating a free market, the need for Medicaid and Medicare diminishes and eventually goes away.
2. Direct taxes on the middle or lower class as they are the bulk of the voters
3. Anything that reduces government income (i.e., HSAs, Vouchers, leveling of tax treatment for all health care expenditures)
4. Increasing the deficit as a result of health care – it is politically unpopular and destructive
Reforms politicians will fight for:
1. The increase of Medicaid
2. Stability and continuity for Medicare
3. A public option (for several reasons, including that this is the surest way to raise enough money without making it look like they are raising taxes)
4. Additional tax revenues
5. Pre-existing condition reform
6. Cap out-of-pocket maximums
Unions
Reforms they will fight against:
1. Reforms that limit an employer’s ability to limit retiree medical any time in the future
Reforms they will fight for:
1. A mandate that makes employers cover 100% of their workforce
2. Securing retiree medical insurance
The Socialist Movement
Reforms they will fight against:
1. The repeal of the anti-trust exemption on insurance companies. (The socialist cause is one for more government programs – not open or free markets.)
2. Free market health care reforms
The reforms they will seek for are:
1. A single payer health care system
2. Taxes on the wealthy to pay for it
Doctors & Providers
Reforms they will fight against:
1. A public option that reimburses at the same level as Medicare or lower
2. Pay-for-performance
3. Allowing the government to negotiate directly with drug companies.
Reforms that Doctors & Providers will work for:
1. Employer Mandate
2. Health Care exchange
3. Pre-existing condition reform
4. Reforms that help them earn more money
5. Pharmaceutical companies will try and expand their drug penetration (i.e., end the ‘doughnut hole’ in Medicare)
Individual Citizens
Reforms citizens will fight against:
1. Raising taxes on the majority of Americans
2. Reforms that appear to be un-American
Reforms we will fight for:
1. Better care for all Americans
2. Lower costs
You probably noticed that most of these players don’t represent groups that are trying to open up markets, create competition, end the status quo or truly lower costs. That is the reason why we are not going in direction that would truly benefit America.
There is of course the CATO Institute and other free-market Washington think-tanks that will try to urge Congress in a free market direction. However, they are not supported by the other players – or even a majority of the people. Sadly, freedom doesn’t have a strong lobbyist because most people receive their information from the media, support politicians rather than policies, work for employers, go to doctors, and belong to unions.
Which of these lobbying forces is the most powerful? It is hard to say as each of them carries a tremendous amount of force with them. Because of this, the reform that will ultimately happen will be a compromise between all of these different sources. You can guarantee that it will include “wins” for all of these players.
Freedom, justice and the proper exercise of agency, is predicated upon education and understanding. We can never hope for that from these major players. Being aware of the largest players and the kinds of reforms they desire will enable you to more properly perceive the kinds of reforms being discussed – where they originated and who they benefit. Only then will we be able to accurately recognize the kind of reform being debated in Washington.
The answer? Because of politics, self interest, a fear of losing power and a belief that the status quo will continue to work in the future as it has “worked” in the past. The answer lies in a compromise among all of these forces represented by the different lobbying bodies in Washington. I am well acquainted with many of them.
These lobbying forces are many and strong. To name a few, they are:
1. The Insurance Industry
2. The Corporate Lobby
3. The Insurance Broker Lobby
4. The Media
5. Politicians
6. Unions
7. The Socialist Movement
8. Doctors & Providers
9. Individual Citizens
By looking at each one of these players you will get a sense for the reforms that will actually come out of Washington and why. I will briefly touch on each one of these.
The Insurance Industry
The insurance industry will obviously fight against several things:
1. Ending their exemption from the Sherman Anti-Trust Act
2. A Public option that would compete with them
3. Opening up competition against co-ops & health shares
4. Opening up competition of insurance companies across state lines
5. The end of the employer sponsored health plan
6. Opening up the exchange to those who already have insurance
7. Cap out-of-pocket maximums
8. Pre-existing condition reform
They will fight for:
1. A mandate that says everyone should have insurance – even at the expense of businesses
2. Tools that allow them to negotiate down prices
3. An exchange that makes it easier for people to buy their insurance who didn’t already have it
The Corporate Lobby
The Corporate Lobby will obviously fight against several things:
1. A mandate requiring them to “pay or play”
2. Repealing the tax deduction on contributions to employer sponsored health plans
3. Not allowing them to participate in the health care exchange
4. Taxation on “Cadillac Plans”
They will fight for the following:
1. Small business exemption to any mandates
2. Credits that make it easier for them to provide health care
3. An open health care exchange
The Insurance Broker Lobby
This lobby will fight against:
1. The end of the employer sponsored health plan
2. Any kind of tax increase on employers
3. Anything that damages the insurance industry
Reforms they will fight for:
1. Reform that would bring more people onto employer sponsored health plans
The Media
I don’t believe they will “fight” against anything. Although they may not cover, or give air time to important reforms such as:
1. Elimination of the anti-trust exemption for insurance companies (they support the media through advertising)
2. In depth coverage of free-market reform
Reforms that most of the media will fight for:
1. A Public Option – within 45 minutes the other day I saw “How American Healthcare killed my Grandfather” and Bill Maher accusing America as being the only developed nation that “get’s rich on people’s misfortunes.”
2. Coverage for everyone
Politicians
Reforms they will fight against:
1. The overt end of the employer sponsored health plan
· Why would they not fight for this? It is because it goes hand in hand with Medicare and Medicaid. Medicare exists only because of the dominance of employer sponsored health plans because most employers don’t insure people after they retire. Therefore, the government can do that instead. Furthermore, Medicaid also exists primarily because of the employer sponsored health plan because employers don’t insure the unemployed or non-working class. Therefore, the government has a program to take care of them too. These are two programs built around employer sponsored health care. By eliminating the employer sponsored health plan and creating a free market, the need for Medicaid and Medicare diminishes and eventually goes away.
2. Direct taxes on the middle or lower class as they are the bulk of the voters
3. Anything that reduces government income (i.e., HSAs, Vouchers, leveling of tax treatment for all health care expenditures)
4. Increasing the deficit as a result of health care – it is politically unpopular and destructive
Reforms politicians will fight for:
1. The increase of Medicaid
2. Stability and continuity for Medicare
3. A public option (for several reasons, including that this is the surest way to raise enough money without making it look like they are raising taxes)
4. Additional tax revenues
5. Pre-existing condition reform
6. Cap out-of-pocket maximums
Unions
Reforms they will fight against:
1. Reforms that limit an employer’s ability to limit retiree medical any time in the future
Reforms they will fight for:
1. A mandate that makes employers cover 100% of their workforce
2. Securing retiree medical insurance
The Socialist Movement
Reforms they will fight against:
1. The repeal of the anti-trust exemption on insurance companies. (The socialist cause is one for more government programs – not open or free markets.)
2. Free market health care reforms
The reforms they will seek for are:
1. A single payer health care system
2. Taxes on the wealthy to pay for it
Doctors & Providers
Reforms they will fight against:
1. A public option that reimburses at the same level as Medicare or lower
2. Pay-for-performance
3. Allowing the government to negotiate directly with drug companies.
Reforms that Doctors & Providers will work for:
1. Employer Mandate
2. Health Care exchange
3. Pre-existing condition reform
4. Reforms that help them earn more money
5. Pharmaceutical companies will try and expand their drug penetration (i.e., end the ‘doughnut hole’ in Medicare)
Individual Citizens
Reforms citizens will fight against:
1. Raising taxes on the majority of Americans
2. Reforms that appear to be un-American
Reforms we will fight for:
1. Better care for all Americans
2. Lower costs
You probably noticed that most of these players don’t represent groups that are trying to open up markets, create competition, end the status quo or truly lower costs. That is the reason why we are not going in direction that would truly benefit America.
There is of course the CATO Institute and other free-market Washington think-tanks that will try to urge Congress in a free market direction. However, they are not supported by the other players – or even a majority of the people. Sadly, freedom doesn’t have a strong lobbyist because most people receive their information from the media, support politicians rather than policies, work for employers, go to doctors, and belong to unions.
Which of these lobbying forces is the most powerful? It is hard to say as each of them carries a tremendous amount of force with them. Because of this, the reform that will ultimately happen will be a compromise between all of these different sources. You can guarantee that it will include “wins” for all of these players.
Freedom, justice and the proper exercise of agency, is predicated upon education and understanding. We can never hope for that from these major players. Being aware of the largest players and the kinds of reforms they desire will enable you to more properly perceive the kinds of reforms being discussed – where they originated and who they benefit. Only then will we be able to accurately recognize the kind of reform being debated in Washington.
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