I think it is good to be alert to any discussions that are what I call “downstream of a flawed premise.” Let me explain.  When I hear, for instance, that the “flat tax” is preferable to the current income tax, I think to myself that this is a discussion of the knife versus the axe, a conversation far downstream of one addressing government spending or the very legitimacy of denying someone their earnings.  After all, victims don’t generally care what the mugger does with their money.  They just resent being mugged and no discussion about whether the mugger was holding a knife or a gun will likely provide any solace.

Similarly, I would argue that arguing for everyone to have health “coverage” is far downstream of the more original problem:  the cost of healthcare.  To provide “coverage” for everyone in the climate of gross overcharging primarily serves the interests of those who employ the “what can I get away with” method of medical pricing.  The fierce push back against true price transparency by the cronies in the medical industry makes more sense in this context, as price honesty denies them access to everyone’s blank checkbook as the health cronies are well aware.  

Supporters of government-guaranteed “coverage” object with the following arguments.  First, coverage is equated with healthcare.  While millions of Canadians streaming across the border to secure their health needs could be used to refute the idea that coverage is synonymous with care, this non-equivalency has become more apparent in this country.  Each passing day reveals Medicaid and Medicare “coverage” to be a “black mark,” an actual obstacle to obtaining care, as these government programs and their associated rationing through price controls are creating the lines the central planners intended.  Physicians are either dropping out of these programs altogether or they are limiting their exposure to patients with this “coverage.”  

Another objection points to the relief from financial devastation that having “coverage” represents.  Keep in mind that not only are well over half of the bankruptcies in this country medically related, but almost three quarters of those filing for medical bankruptcy have insurance.  This points powerfully to cost as the root cause of medical economic ills.  Acknowledging this is a slippery slope for the objector, however, for no economic system better provides for resource allocation than the market and the cronies and their government pals know this as well as anyone.  The market is the only source of price deflation with simultaneous improvement in quality. This powerful competitive mechanism has brought affordability to countless products and services in all industries and has begun to bring rationality to health care pricing as more physicians and facilities honestly post their prices for all to see.

Rather than focus on “coverage,” which allows the cronies to continue their financial feeding frenzy, we should remain unalterably focused on cost.  The competition unleashed will result in a medical price deflation the likes of which will cause even the most skeptical to re-evaluate the role of “coverage” in the provision of payment for health care.  This is no prediction.  This is exactly what is happening here in Oklahoma where so many have embraced the same market discipline every other industry must endure.  The reasonable prices and high quality of care, having such a wide appeal, have rendered Oklahoma City a medical tourist destination for many patients far from here, while simultaneously bringing savings in the millions of dollars to those who actually pay for healthcare, locally.  This is my answer to another objection from those who claim the inapplicability of the market to health care.

Whether the focus on “coverage”  is a deliberate distraction by the crony propaganda machine or a well-meaning but misguided strategy thought to provide better access to care, we must keep our eyes on the “price transparency ball.”  The Oklahoma market is already harshly judging those attempting to avoid this gaze and I believe this trend is likely to continue as long as we refuse to discuss conclusions downstream of a flawed premise.

G. Keith Smith, M.D.