My thirteen-year old boys had an appointment this week. When we were done the provider who normally chats with me in that provider-to-provider way abruptly changed the conversation to tell me he finally deciding who was getting his vote. I was expecting this to be the lead in to some new Donald Trump joke. However, he showed me a map of the electoral college on his phone with several states in orange and said, “Libertarian, I’m voting Libertarian. That’s the future.”
I looked at him as my kids hovered in the door wanting to leave because there were Pokemon to catch. It took me a few second to realize he was serious. He pressed on about Obamacare not working (which I take as code for premiums being outrageously high) and what did I think?
I explained my views on Obamacare. That if health care reform is a ladder with 100 rungs Obamacare is the first rung. It is far from perfect, but at least it moves us in the right direction. That I understand political change and true reform is a long game. I used my standard go to reference for imperfect documents, the Constitution. If it were perfect when it were written we would have no amendments. We didn’t re write the whole thing each time an amendment was needed.
He was unconvinced and shook his head. The Libertarians, he argued, had a better way,
I told him his vote was his right and that I was voting for Hilliary. And then I added, “If your guy is elected I hope you never get sick.”
He looked taken aback. ‘”What?”
I pulled Oliver into the office. I asked if one day he needs heart surgery, like Oliver will again, will he have saved enough to pay the bill or is he just going to roll the dice with a charity hospital or perhaps fly to India?
“Well, Obamacare isn’t that great, is it?” he countered not answering how he would pay for a heart vale replacement.
At this point I pulled both boys back into the office and explained that their care combined was well over one million dollars in the NICU. Since then heart surgeries, intensive care units stays, and home oxygen. If this were a Libertarian health care system no insurance would have covered them. They’d have crafted a way to get out of it, by preexisting conditions or caps on costs per condition. I’m a doctor and I couldn’t have afforded the care they needed to survive. In countries without regulated health insurance parents have to pay in advance or their children don’t even get admitted to the intensive care unit at birth. Even if I’d sold my house when they were born and had a robust health savings account I’d have been bankrupt by the time they were five or six weeks old.
His answer, “Maybe we shouldn’t be saving those kids.” He looked embarrassed that he’d said it.
I wasn’t shocked or angry. That is the only logical conclusion under a Libertarian health care system. I knew that, so I wanted to make sure he did too.
He got flustered and muttered something about still being his patients. I told him I didn’t hold it against him, and walked off absolutely bewildered that someone with a graduate degree in health care could think that voting for a Libertarian was good for his own family. I honestly believe it is because people have bought into the Libertarian lies about health care or that they think it’s some kind of protest vote against the cost of health insurance, but if you are going to vote Libertarian you should understand exactly what that means next time you get sick.
Th Libertarian myth is that health care was awesome in the 1960s because doctors made house calls, a hospital stay only cost a few days pay, and there were charity hospitals. I’m not being tongue in cheek, those words are lifted directly from their web site. Yes, relying on charity is part of their plan.
This is just false. Health care was too expensive for many in the early 1960s, especially for the elderly, who often spent their life savings on their health. That is why Medicare was introduced. No one would have introduced Medicare if everything were perfect. That’s not how governments work. 1960s medicine was only Norman Rockwell if you could afford it. In a 1963 survey 25% of people said they did not see a physician because of chest pains, 40% said they didn’t see a doctor if they had diarrhea for five days, and 35% of people with shortness of breath did not consult a physician. In 1963 the rate of hospital admission was 15% with private insurance and 9% for those without. By 1970 the rates had equalized to 13% due to Medicaid and Medicare. And charity hospitals and clinics? Well, ask doctors who have worked in them if that’s their ideal health care. I’ve worked in free county clinics and it’s patch work by dedicated professionals doing their best with little or no resources. It’s not health care, it’s health suboptimal care.
Comparing cost of care today with the 50s and 60s is ridiculous. Sure, we have too much bloat in the system and I’m eager to fix that, but keep in mind in 1959 a heart attack was managed with an EKG and nitroglycerin and oxygen. Now we have blood tests to diagnose heart attacks, medications to dissolve clots, 24 hour a day monitoring, angiography, stenting blocked vessels, and coronary artery by pass grafting. None of that expensive care existed in 1959. What about prematurity? Babies born at 34 1/2 weeks had a 40-50% chance of survival. At 26 weeks babies like mine were just wrapped up and left to die. If their mothers were lucky they got to hold them as they died. Guess when doctors starting thinking maybe they could cure some cancers with chemotherapy? Late 50s/early 60s. Obesity, a big driver of health care, was also much less prevalent.
Of course it was a cheaper and more efficient system in the 50s and 60s. The poor didn’t come in for care and none of today’s expensive care existed to offer those who did! People also walked more because there were no four car families and didn’t eat the junk food we had today.
The Libertarian party has these three ideas for health care:
Excellent. Don’t get cancer. You won’t be able to pay for it. Same goes for heart disease and premature deliveries and just about any chronic care. Maybe you’ve saved really well, but then your mom falls and breaks her hip. She doesn’t have the $30,000 to pay for the surgery because she used all the money to pay for your dad’s chemo last year. Do you say sorry mom and let her die, even though the surgery could give her another 15 or so years, or pay for her care and then hope your kids don’t get sick while you build up your funds again? Hip surgery in this situation is best done within 48 hours so you don’t have a few weeks to think on it. Tick tock, what do you decide? The Charity hospital is full.
Let’s say I had been able to come up with the $1 million to get my kids through the intensive care unit, after he was discharged Oliver had 10 admissions for pneumonia (two to intensive care units), two heart surgeries, home oxygen, physical therapy and occupational therapy. Never in several lifetimes could I have saved enough money for his care.
Mandating coverage for specific disabilities and disease protects people because insurance companies love to not cover expensive care. That’s why they invented preexisting conditions. Cancer is expensive let’s drop that! Oh, and Pap smears why pay for that? We don’t cover cancer anyway, so hope they’ve saved up! Prematurity? Well, there’s a $100,000 cap on that. Mental health? Great, we pay $25 a visit find a provider of your choice! Can’t find a psychiatrist to take that? Oh, sorry.
Mandates exist because most health insurance companies are trying to not pay for expensive care. The free market has already shown us what will happen without government oversight. Pre Obamacare if you had a preexisting condition coverage was inadequate at best. Who knows what a free market might decide, maybe obesity will become a preexisting condition and eligibility and rates will be calculated based on body mass index (BMI)?
Sure the FDA has all kinds of issues, but a free market wants to do the bare minimum in studies. Drug companies are already not releasing unflattering studies with the regulation that we have, so you really think this will get better with less regulation? I can’t even validate this propranolol reference. Propranolol has been on the market since 1965 and generic as long as I’ve been a doctor (since 1990). I’m not aware of any 10-year delay in modern health care with this medication.
As for the real value of regulation I’ve got a one word for the Libertarian party, thalidomide.
Health Care the Unites States is Far From Perfect
That is about the only thing I agree with when it comes to the Libertarian party platform, however, the idea that people can get good medical care in a completely free unregulated market is a lie. We know this because it didn’t work in the 1960s. We know this because in countries with little access to health insurance the poor go without basic health care and people get what they can pay for up front. A free market isn’t going to reduce the cost of by pass surgery and four days in the hospital to $500 (which I might add is a lot of money for many people).
If we had Libertarian health care system in 2003 when my children were born one or both of them would be dead. My health insurance was shitty, even as a doctor working at a University. Medicaid covered close to $500,000 in intensive care unit costs alone. In a Libertarian country they would have looked at our insurance and asked for $100,00 or more up front for each child and if I didn’t have the cash they wouldn’t have received care or they would have been transferred to an over worked charity hospital that often ran out of medications and had 30 year old ventilators.
The Libertarian platform on health care is either woefully under researched, a sad fantasy, or a willful attempt to camouflage the callousness that it represents with 1960’s nostalgia and buzz words.
If you’ve voting Libertarian you should know that.