Devon
Herrick | Posted: Apr 13, 2020 12:01 AM
The opinions expressed by columnists are their
own and do not necessarily represent the views of Townhall.com.
Many people have come to believe that the only way to
protect Americans against future pandemics is to turn over control of our
health care system to the government. The folly of this view was apparent when
the U.S. Centers for Disease Control & Prevention (CDC) utterly failed as
the monopoly supplier of COVID-19 diagnostic testing kits. When the first cases
appeared, about half of the test kits failed and replacements were slow in
coming. In addition, the federal response was to issue a state of emergency
that literally stopped private labs and universities working on alternative
tests in their tracks. At that point, any work on COVID-19 test development
required an Emergency Use Authorization from the U.S.
Food and Drug Administration (FDA). Valuable time was lost when scientists had
to stop what they were doing to apply for permission to develop COVID-19 tests.
Also lost was the opportunity to engage in large-scale testing and quarantine
hotspots before the coronavirus had spread.
How would a free market health care system respond to a pandemic?
For one thing, most Americans would have more options and more control over how
their health care dollars are spent. Millions of Americans would likely have
more products in their medicine cabinets to assess their health status and
provide their physicians with better, faster information. Americans would
likely have higher tech versions of many of the items they possess today, like
blood pressure cuffs to manage hypertension and pulse oximeters to assess
oxygen saturation. They may have more advanced items such as iPhone EKGs and
smartphone endoscopes allowing their doctors to examine cardiac health and
throats remotely. Patients would also likely have smart thermometers that
updated their personal health records automatically in the event of a fever and
notified their physicians wirelessly.
Engaged patients may even want a computer app that tracks
their health, advises them on developments and contains far more information
about their health status than their physicians’ files contain today. Many
Americans use programs like Quicken to track their finances. Under a
free-market health care system with Large HSAs or MediSave accounts (like in
Singapore) consumers may have Quicken Health to
manage their medical care. Patients would input health complaints for their
doctors to review. The sponsoring software developers would aggregate anonymous
data with millions of other Americans, drawing inferences on diseases,
conditions, health status and therapies to prevent or better manage chronic
conditions.
Under a system where Americans control much of their health
care spending, most doctor visits would probably be the result of Quicken
Health suggesting patients schedule a consult for a new medical development
from a lab result. Physician visits could be on the phone or online similar to
a Zoom meeting. Multiple firms would compete on price and convenience to make
laboratory and diagnostic testing easily available at rates far below what many
pay today. People experiencing a fever would quickly notify their doctors
electronically, allowing others to know when and where social distancing was
necessary due to flu, colds or worse. It would also allow health authorities to
track pandemics or flu season exposure in real time.
Under a free-market health care system, consumers would have
more options because providers – hospitals, doctors, clinics and drug makers –
would compete for patients’ patronage with patient-pleasing amenities. (This is
already done in the cosmetic medical marketplace, by the way).
Why is our health care system so bureaucratic and expensive?
There are a variety of reasons, but the government is the biggest culprit. A
70-year old tax law is why millions of Americans have health insurance through
their jobs rather than personal and portable health insurance. Rules on medical
licensure, scope of practice along with FDA regulations make our health care
system more bureaucratic than need be. Virtually all medical care, other than self-care
with over-the-counter medications, must begin with an in-person office visit to
a licensed physician. Telemedicine has been slow to catch on because third
party payers are never on the lookout for new ways of spending their money. By
contrast, consumers are always looking for more convenience and better deals.
A critical shortage of personal protection equipment
endangered health care workers when the demand far exceeded the supply.
Although it isn’t difficult for manufacturers to produce such things as
ventilators, masks, gowns and gloves, what is difficult is getting FDA approval
to market them. The process takes from months to years in some cases. It wasn’t
always that way. Earl Bakken and his brother-in-law, the cofounders of
Medtronic, literally developed the first cardiac pacemaker in their garage. It
was the late 1950s and their prototype was tested in a hospital and put to use
saving lives about a month later. Nowadays all medical equipment must go
through a rigorous process of regulatory compliance with design, good
manufacturing practices and approval to market prior to being offered to the
public. Although quality is important, this raises prices and creates barriers
for aspiring entrepreneurs hoping to produce medical supplies and equipment.
If the health care marketplace were less regulated, patients
would also have greater rights to try experimental and novel medicines than
they have today. Chloroquine and hydroxychloroquine are both antiviral
medications to treat malaria. They are also used to treat autoimmune disorders
like rheumatoid arthritis and lupus. There is anecdotal evidence that
hydroxychloroquine, azithromycin (an antibiotic) and zinc (a dietary
supplement) may reduce COVID-19 symptoms in some patients. Yet, some state
medical boards have moved to restrict COVID-19 patients’ access to these drugs
because they believe the science does not yet support off-label
prescribing.
The U.S. health care system is bureaucratic, costly,
inconvenient and decidedly nonpatient-friendly. It doesn’t have to be that way.
This essay is based on a Heritage Foundation report coauthored with John C.
Goodman.
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