morgan_polotan Posted January 31, 2011 Report Share Posted January 31, 2011 *This is a guest post by Thomas Hochmann, of Objectivist Voice. Setting aside the very important issues of rights, free markets, and the like, there is an interesting consequence of government interference that often gets overlooked: government control inevitably seems to lead to people being just barely held in check by an ever-growing myriad of laws. This is increasingly true with health care, and specifically with Obamacare. Rather than have contract-based interactions between consumers and providers that can be handled in rational ways, and (when necessary) enforced by objective court systems, we have an environment where everyone is increasingly at everyone else’s throat. In “Obamacare Criminalizes Medicine,” Shikha Dalmia offers two examples. First, there’s the government versus its own citizens, especially those in low-income households: “When the government hands out subsidies, it will use a household’s income in the previous year as the basis for guessing what the household is qualified to get in the current year. But if the household’s income grows midyear, the subsidy recapture provision will require it to repay anywhere from $600 to $3,500… This will make it very hazardous for poor working families to get ahead. In the original law, the loss of subsidy with rising income already meant absurdly high effective marginal tax rates—the implicit tax on every additional dollar of income earned. How high? The Cato Institute’s Michael Cannon puts them at 229 percent for families of four who increase their earnings by an amount equal to 5 percent of the federal poverty level or $1,100. In other words, a family that added this amount to an income of $44,700 would actually see its total income fall by $1,419 due to the loss of subsidies.” This subsidy “recapture” mechanism will have government agents chasing after low-income workers, forcing them to give back government money because these people had the gall to advance themselves and improve their income. Shikha predicts that with this threat looming overhead, recipients of these subsidies will feel pressured to fudge the numbers on tax returns or to work for cash under the table — thus creating whole new problems, and (I would expect) leading to further enforcement measures to reign in this government-encouraged “fraud.” Never mind that none of this would be necessary if we had a government that did not provide these wealth-redistributing, gunboat altruism programs in the first place. Second, Shikha points out extensions to the government’s already-existent “rat out your colleague” system for whistleblowers in the medical industry who report fraudulent Medicare claims. Doctors will be increasingly subject to searches by private “Recovery Audit” contractors who will be “authorized to go to doctors’ offices and rummage through patients’ records, matching them with billing claims to uncover illicit charges.” Actual intent to defraud the government will not have to be proven, and billing errors can be fined $50,000 each. Government versus low-wage citizens? Check. Doctors, nurses, and private mercenary contractors versus each other? Check. Giving doctors yet another massive financial risk to worry about? Check. This is not new to Obamacare, however. In a 1985 lecture titled, “Medicine: The Death of a Profession,” Leonard Peikoff highlighted the government intervention in place at that time. As he called it, the official “dropping of the noose” around doctors’ necks came with the introduction of DRGs, or “diagnosis-related groups.” With DRGs, the government would pay a fixed, arbitrary fee to a hospital based on whatever was diagnosed: “For example, for a Medicare patient in the Western mountain region who is admitted to a hospital with a heart attack and finally recovers enough to go home, the government now pays the hospital exactly $5,094 — no more and no less. And it pays this no matter what the hospital does for the patient… If the patient costs the hospital more than the government payment, the hospital loses money on him. If he costs less, the hospital makes a profit.” An obvious, immediate conflict of interest is introduced here. If a hospital receives the same payment regardless of how long a patient stays, how much or how little care he is actually provided, etc. then the hospital has an incentive: save as much money as possible, and get the patient out as quickly as possible. Peikoff outlines how this can easily pit doctors and administrators against each other: doctors (hopefully) trying to do right by their patients and provide the best care possible, and administrators (likely) trying to minimize costs and losses. It’s not hard to see how this also raises suspicion of doctors in the eyes of patients: is my doctor doing the best he can to treat me, or is he going to cave to the government-imposed bottom line? The government versus its own citizens; doctors and nurses versus each other; hospital administrators versus doctors (and by proxy, their patients); patients versus their doctors and their good intentions. Socialized medicine makes enemies out of everyone, and the webs of suspicion, distrust, fudged numbers, fraud, and “recapture” simply multiply with each new law that gets passed. It’s not bad enough that some people actually demand that doctors be servants to the creed of need (“I think it’s disgusting for doctors to make a profit,” one protester shouted on a TV broadcast I saw last year). With the creed of need enforced by government mandates, we end up with a system littered with servants and criminals on both sides of the equation. “There is nothing left but the coercive apparatus of the state to keep patients and doctors in line. This would be unimaginable where the customers receiving or contracting for services are actually the ones paying for it. If Whole Foods “overbilled” its shoppers, they would just go to Trader Joe’s. No one would think of summoning the police. If a mechanic submitted unjustified bills to All State Insurance for car repairs, All State would contract with someone else. There would be no need for an FBI stakeout.“ ~ Shikha Dalmia, “Obamacare Criminalizes Medicine“ Cross post Quote Link to comment Share on other sites More sharing options...
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