Wonder of wonders—my local liberal daily paper did a front-page story about disastrously higher ER use by CA poor people. “ER Visits Soar for Medic-Cal Patients” is the title which you may be able to Google.
The wonder is the article, full of facts and logic, places the blame entirely on Obamacare and Democrat elected officials in CA.
It is not a hit piece against Dems. Rather, it is—wait for it—honest journalism. Tracy Seipel is the author of it.
The main impetus for Obamacare and Romneycare in MA was to get poor people to stop using emergency rooms for routine care. ER care is extremely expensive compared to very expensive non-ER care.
Turn non-emergency patients away from ERs
There is a simple explanation for that. ER care is free for the poor and it is against the law—still against the law even though Obamacare passed—to turn them away.
In CA, the situation is complicated by CA being cheap when it comes to reimbursing regular doctors, so the doctors refuse to see even patients specifically assigned to them.
Fundamentally, Dems want to make people change their behavior—not just in health care—but in everything. I happen to have more than average training and experience at that.
You need both carrots and sticks to get people to change their behavior. But, to the Democrats’ great annoyance, America is a democracy. That means they have to get a majority of electoral votes.
Results, but not votes
But although sticks are sine qua non for getting results, they don’t get votes. Which, in turn, means politicians cannot lead or manage the nation. They are stickless.
Hard ass or nice guy
Similarly, during our first two years at West Point, we cadets often debated which was the right way to lead: hard ass to nice guy. Both were present in the upperclassmen who led us. We were about evenly split on which was best. I favored nice guy.
I was wrong. So were the guys who favored hard ass. The debate among us ended junior year. Why? Freshmen and sophomores then were all cadet privates—in charge of nobody. Many juniors were corporals, which meant squad leaders, and all seniors were sergeants or officers and in a wide range of leadership positions from intramural coaches to platoon leaders to guards. Once you actually get put into a leadership position, you learn that using only hard ass or only nice guy only gets some of the people to do what you want. But your job is to get them all to do what they are supposed to.
As with carrots and sticks, you need BOTH nice guy and hard ass in your repertoire to be a successful leader. The reason is some people respond to nice guy and some respond to hard ass, and probably we all have aspects to our lives where we need to be hard-assed because we simply don’t like some of the things we ought to do—like maintaining a healthy weight.
Nice guys win elections; hard asses don’t
The solution is high cost health care in America is to repeal the law forcing ERs to give free care to all comers and to totally deregulate health care and to reform tort law in America. This is roughly the way America was before the New Deal.
Was it perfect? No. Nothing is. Was it adequate? More or less yes. What I envision would be better, but the key political variable would be how generous the non-poor are with regard to helping the poor.
Before the New Deal, the poor went to religious and other charity hospitals. That is part of why such organizations went into the hospital business in the first place. Now, we tend to think all hospitals are charities. That is because they have been ordered to be. Another way to put it is we have socialism in medicine. But socialism doesn’t work. Which takes us back to the fourth paragraph above.
Deregulation would cause an explosion of competing for-profit hospitals and health care would be like groceries—ubiquitous and affordable. The poor, who have been the tail that wagged the American dog since the New Deal, would have to get a job (I pause so liberal readers can clutch their hearts in horror) and stop being poor or beg for health care. Some of each would happen.
Merely being poor also responds to sticks. If you stop subsidizing the poor, there will suddenly be fewer of them. Duh. And those who remained would be helped by family, friends, charities. The militantly self-inflicted drug addict, alcoholic, and refuse to take responsibility poor would probably get what they deserve. About time. That’s another deterring stick with regard to the future drug addicts, alcoholics, and refuseniks.
We must have separation of charity and state because the stickless, lying, nice-guy politicians will use any authority they are given to buy votes and will promise and spend and tax and borrow until the government goes bankrupt, as they are currently doing. Politicians will never get a stick or turn hard ass.
The solution is to reduce the scope and authority of politicians to affect our lives and increase the private sector’s scope and authority. The Laws of Economics force the private sector to use both carrots and sticks and to be both hard asses and nice guys. Consequently, capitalism, unlike socialism, actually works.