Three reasons why the conservative approach to healthcare is the right one


– Hey everybody. This week we are going
to talk about healthcare. Healthcare, healthcare, healthcare. The importance of healthcare
cannot be overstated. Today I wanna give you three reasons why the conservative approach is the right one when
it comes to healthcare. And the reason why I wanna
go about it this way, it’s helpful to first
understand the principles through which we approach problem solving. It’s important that we
frame the broader debate before we get into real
detailed policy discussions. And that’s what I wanna
talk to you about today, the broader debate. How do conservatives view healthcare? How does that differ from the left? And why does our approach make more sense? Well here’s why really quickly and then we’ll get into more detail. First, sustainability. Sustainability means
fiscal sustainability, meaning can we afford it in the long run. It also means sustainability
from an operational level, from a bureaucratic level. You know, how complex is this system. Is it really manageable
from a federal stand point. The second thing is trust. Trust that the local
level can find a solutions that are required for the people within a municipality or within the state. And also trust with doctors. Trusting doctors to
actually run healthcare and manage that doctor
patient relationship. Third, it’s the way we view healthcare and not necessarily meaning coverage. Meaning, we view healthcare
as access and outcomes not just insurance coverage. So, let’s into some detail here. Democrats and Republicans agree on the importance of
healthcare but the debate over how to achieve a better system has unfortunately devolved into these extreme and unrealistic policy proposals. The Democrats are increasingly
pushing for single payer or Medicare for all solutions. They claim that’s the simplest
and cheapest solution. But is it? First, this claim that
purely free or cheap is pretty misleading. A recent study estimated
that it would cost 32 trillion dollars over
the course of 10 years. That requires massive tax increases on both the individual
and the corporate level. And wanna we get for the this? Well they would argue the
cost would be worth it because we finally
remove insurance coverage from the equation. Well, that’s not accurate. In practice there’s
actually still a third payer there’s still an insurance company it’s just happens to be the
bureaucrat or the government. Because the entire population
would have to be covered this results in a severe rationing of care and a much longer wait times. Additional regulations, even more than the hundreds of thousands that we see every single year through HHS. They would have to be written and rewritten to manage the care. These results have been well documented in countries like Canada, Great Britain where a nationalized
healthcare system exists. And it’s only been getting
worse there so much so that they’re actually
lookin’ to privatize a lot of their healthcare industry to increase the quality of care and
decrease wait times. Here’s another important point, to justify this type
of system that the left will claim that healthcare is a right, now, that doesn’t sound all
so bad when you think about it we would all like everyone
to have access to heath care but is this carefully worded language because it implies that
the government must then protect your right and
provide accordingly. Now that’s the problematic part. The founders new at this, the
founding fathers new this, which is why they defined
rights very carefully. The common thread between
all the inalienable rights in the constitution, life, liberty, the pursuit of happiness,
freedom of expression, freedom of religion, et cetera. These are rights that do not
infringe on someone else, if we define healthcare as
a right we are effectively conscripting healthcare providers into our service through the force of government, that’s an important point. What happens when doctors no longer wanna practice or be in the system? Do we force them to go to medical school? Then once they graduate
do we force them to take a certain level of pay? Do we force them to be in the system that we’ve created for them? Where does it end, how
does it get managed? How big of a bureaucracy do
you need to enforce that? It’s not just problematic, I
mean it’s a real fatal flaw in this kind of reasoning. The idea that a government bureaucracy can effectively manage
a system as complicated as American healthcare,
it’s fatally flawed. And it’s hard to compare to a place like Great Britain and Canada
by the way because well we’re much larger,
we’re much more diverse, we have different preferences
across huge lots of territory. In addition to that, you cannot
have a right to something that is finite or scarce. Healthcare is a limited commodity. Unlike your right to
speak or pursue happiness which you can do as
much as you like as long as you’re not infringing
on somebody else’s right. But you cannot have an
inalienable right to a service that is administered by another person. That is an important point. So, using language like
healthcare is a right which again, doesn’t sound
all that bad at first, it’s meant to trap you into
excepting a totalitarian control over the whole system. So, this brings us then to the
other side of the argument. Does that mean that a purely free market system is the answer? We gotta think carefully about that also. So often we look at examples
such as plastic surgery or lasik for your eyes,
as cases where the free market has driven prices down. But we need to be careful there too because those aren’t great examples they aren’t really healthcare, they’re more of a service. No one actually needs those
procedures, they just want them. Actual healthcare markets are different from regular markets because
of the human element. People need certain healthcare services and our system, our society
doesn’t deny care, period. In that sense, we already
have universal healthcare but the spreading of cost and the delivery of services are highly inefficient being a mix of market forces and highly regulated government programs. In a purely free market, pure free market, we would run into problems with healthcare primarily because the
poor or the very sick would be unable to afford insurance or be eneligble for insurance. There isn’t a free market
incentive that would fix that problem so we
do have what economists call a market failure. With other goods and services, you know, luxury goods, cars, we can
except the idea that the poor simply can afford as much as the wealthy. But with healthcare we do have an interest as a society in finding ways for the poor and the elderly to
access basic healthcare. Even if we didn’t cover these individuals with programs such as
Medicaid and Medicare we would still not block a sick individual from the emergency room
so the cost is present weather we like it or not. Our current mixed system
ends up being actually pretty good for the poor and the wealthiest but terrible for the middle class. The middle class suffers
because they aren’t eligible for aide, like Medicaid, like the poor are and they aren’t wealthy enough
to afford the best care. The increasing premiums and
deductibles are rendering them functionally uninsured,
even though they have an insurance card in their
wallet, so that’s a problem. So, that brings us back to the question what is a reasonable debate
to have with healthcare? If we understand that
healthcare cannot be a purely free market and we clearly see that single payer system would be disastrous, then the right policy debate
occurs somewhere in the middle. Right now we’ve gotta system
that is far too over burdened with regulation and severely
hampers free market for us. Again, what is the one
force in our society that has proven to drive prices down? It’s the free market. So you have to have an enormous
element of our healthcare market based in the free
market system with competition. We need to move towards
more freedom of choice not towards more government intervention. Doctors are burning out to
excessive administrative burdens and patients have their
care managed by faceless insurers instead of a
doctor they can trust. They ACA was a product
of an ideological desire for the government to fix things, with penetrating regulation
as opposed to a sustainable system at change and a focus on coverage as opposed to quality
healthcare and access. So yeah, the ACA,
Obamacare, it goes back to a fundamental difference in
how the left sees healthcare they want to fix things
with a group of experts and they focus on coverage
instead of actual care. Ideology does matter when
it comes to how we approach healthcare no matter
what anybody tells ya. It matters because we must
explain why our approach to solving problems is more sustainable but from an operational
bureaucratic level, meaning a more realistic
understanding of what a government bureaucracy
is capable of managing and sustainable at a financial level. Meaning, can we afford
this in the long term? The left would like to
believe that they don’t approach problems with
an ideological framework. They say they are pragmatists
but in fact they do approach with an ideology. First, they believe that complex problems are solvable by small groups of experts. They believe this about most issues and they certainly believe
it about healthcare. On the right, we don’t
necessarily buy into this, with most issues especially healthcare. We believe the governments
rule is in insuring that market incentives are aligned to
achieve desired outcome. In this case, the most cost
effective care for more people. We except that there are vastly different circumstances and preferences
across different regions, across the entire United States, and those all require different solutions. We do not believe that a
group of experts in Washington can be so all missioned,
so all knowing as to perfectly craft a one size
fits all solution for a large and diverse population. This brings me to the
second point of ideological difference, which is local control. The left is ideologically
opposed to local control and local responsibility. Right, they would prefer
more power in the hands of the federal government. We hear it all the time, actually, with respect to a variety of issues. They say, well, federalism
is fine but what if local elected officials or
state governments aren’t doin’ what we believe is
the right thing to do. Well, this comes down to one thing, trust. Remember, that was the
second point I made earlier? Trust, the left does not
believe in trusting the American people to elect local leaders. It does not trust them with more freedom. They do not trust doctors
to manage a patients care and therefore way them down with enormous administrative requirements. On the right we understand
that the only way to preserve liberty and
establish a sustainable society, where demographic culture
differences can be vast is to trust the people to
self govern at a local level. We know they aren’t always
do exactly what they should but we believe in our
system of democracy an we believe in the power of
the people to vote out leaders who are not performing well and not looking out for their interests. The difference in this
ideology manifests itself, for instance, in how we
prefer to manage Medicaid. The ACA or Obamacare was
essentially a Medicaid expansion under the centralized authority of the federal government. The program is administered
by states hoping it would significant federal oversight
that limits flexibilities tailored to local means. So, the left takes a problem,
in this case healthcare coverage for the poor,
which we all agree we should have a safety net for. And then it provides a
solution that is ideologically geared towards centralized control and distrust of local decision makers. The problem of course, is
that this is completely unsustainable on two fronts. One, the level of complexity
required to manage 50 different states,
needs and preferences. And two, it’s unsustainable
because of the endlessly rising costs and account
for a massive portion of our debt and by the way
we don’t even vote on that every year like we should. This is why on the right we prefer block grants for Medicaid. It allows states to
administer Medicaid dollars the way they see fit. So, take Harris County for
instance, in the Harris health system we use those
dollars as reimbursement for healthcare services given
to low income populations. From hospitals like LBJ. We use an 11-15 wavier to
pay for infrastructure. Meaning, facilities,
doctors, instead of coverage. This means we focus on
access not coverage. What good is coverage if
you have no place to go. Now if Texas had block grant on par with other states are receiving
for their Medicaid expansion we could expand that
access and do what works according to the unique
needs of each county. Notice I said county because
even in the state of Texas we have different needs
from El Paso to Houston to Dallas, they’re all different. Innovation in policy and government always happens at the local level. Doctors, hospitals are
all yearning to innovate and figure out exactly how to deliver more and better care. We need to give them
the flexibility to do so because we trust the American people. We know that those
solutions will materialize if we allow them too. Many have already begun. How do we get those
solutions to materialize. I’m give ya couple of
examples of what I’m thinkin’. I’ll tell ya what given
the nature of our current politics it doesn’t seem
likely that an entire massive repeal and replace
bill will go through. I would support it but it seems unlikely. The healthcare industry
shows very little political appetite for massive change,
even though they don’t like what they see now and
they seem to prefer an incremental approach even
your average voter is pretty reluctant to support
changes that would effect their current coverage even if they’re unhappy with their plan. So, on our side what we wanna do is focusing on increasing access, maintaining quality while
also reducing costs. We have to focus on
incremental changes that dismantle these enormous
inefficiencies in the system. One bite at a time. This is what I’ll end
with, I’m gonna end with, what I wanna focus on
the most and what I think shows a lot of promise,
which is the direct primary care model and
how do we incentivize that to expand and increase. We have a massive problem in this country and that’s with preventive care. Meaning, people don’t go
to the doctor early enough they show up to the emergency room they’re already very, very sick. Primary care is the answer to this and a relationship with
you primary care doctor is of the upmost importance. Direct primary care is
basically a model is taking off across the U.S. Where primary care doctors
run their own practice they have a membership
fee and this is cheap, we’re talkin’ 50 to 150 dollars a month. And you can get access to that doctor, now, it’s not insurance,
you still have to buy insurance on top of that. But this gives you access,
right, and they will list a certain number
of healthcare provisions that are allowed in that membership fee. It’s the first step into
the healthcare system. That’s your quarterback,
your primary care doctor. To help you choose what
insurance works for you. To help you choose what
medications work best for you. To help you live a healthier
lifestyle and prevent problems before they occur. Now, how can we push for this? How can we incentivize it
from a government level? Well, first of all let’s let
our health savings accounts actually pay for that. Right now, it’s illegal too. So, that’s the first step. Primary care is the
gateway to the rest of care and I think that’s where we
need to focus our efforts. That’s where we need to
start when it comes to fixing our extremely broken and
expensive healthcare system. Thanks for listenin’. See ya’ll next week.

9 Replies to “Three reasons why the conservative approach to healthcare is the right one”

  1. I think the biggest issue with healthcare is the lack of an exemption-free coverage mandate. One of the main reasons care is so expensive is because people use the ER and then don't (or can't) pay. Another reason is the unreliability of Medicaid payouts.

    This makes hospitals raise prices to offset their unreimbursed expenses, which then leads insurance companies to raise their rates.

    If we create a strictly enforced coverage mandate, it would broaden the pool of people paying insurance premiums while eliminating expensive but unneccessary ER visits. This would lower costs, and while I heartily oppose forcing anyone to do anything, we already require people to buy car insurance because of liability issues. Its the same deal with healthcare. Just like people who get in wrecks, people who go to the ER for everything costs other people money.

    We might also allow Medicaid and Medicare to negotiate pricing with drug companies, and allow insurance to be sold across state lines.

  2. Mr. Crenshaw,

    I like your ideas but I want you to look at this a little differently:

    1) Having a larger local government is a wonderful idea, but then how do you regulate the massive corporations that operate in these local levels? Do these corporations have different rules to follow in each county? While I recognize that major insurers are country-wide and have different policies in different states, overall, they can operate off of a general model. Also 50 types of coverage are easier to manage than 1 in every county.

    2) Harris Health does not work. The wait times are insane, they treat patients like an assembly line, and many do the bare minimum–often missing critical information. I luckily have not utilized this service but have extensive experience with those who do need it from a previous job working with individuals applying for disability that couldn't get quality coverage. More than one died.

    3) The problem with healthcare is the oversight. There is no need for CEO's of these companies to earn $22 million in one year after accounting for salary and the rest of the executive compensation package. Start with regulating the insurance companies instead of giving them breaks. If you do that, costs will come down for the average American making your free market system more sustainable, getting more people off of programs like Harris Health and the ACA. The solution probably isn't single payer or repealing the ACA. It is probably somewhere in the middle.

  3. Lt. Commander Crenshaw,
    I have seen over and over doctors perform at sub par levels in both Dallas and Houston. Doctors killed two of my cousins (won court cases even), and almost killed many members of my family. I have seen Doctors make life costing mistakes frequently. An example being dont give a 80 year old woman with a 9 pound gallbladder a medication that causes people 70 and up to have gallbladder failure and expect everything to be fine. My grandmother almost died Christmas for that mistake. The hospital was terrified of her sueing but she doesnt want to spend her last years fighting. She is a widow. Insurance premiums are high also because of Doctors wanting to protect themselves from being sued, and I have seen doctors refuse service to people for not having insurance. I've seen doctors refuse to treat a rupturing apendix once it was found that pot was in my dad's system. He was a druggy so didnt diserve service. I've seen doctors not deliver pain meds because the patient was cussing in pain, and the doctor was offended by the cursing even though it was over an injury and directed at no one. Maybe if we held our doctors at a higher standard medical costs would go down as well. People do not trust our doctors, our insurance companies, or our government. If we trusted our doctors the rest would follow.

  4. More platitudes than substance with this one.
    You say that we should have health savings accounts and pay a monthly premium to go see a doctor that is separate from insurance. Right out of the gate that would cost over 1k a year according to your average pay scale. That's not even including insurance, cost of medications prescribed for "early intervention" or any other tests that would need to be required. What happens if you need multiple scans?

    We've seen what happens when you just use block grants to states. They will just cut care since they do not have as much money to put into their system. To think that a bunch of better clinics will pop up due to block grants is delusional. I would like to know where this has happened at a large scale.

    We've seen what happens when states pass of many of their disabled population to "managed care organizations". The costs actually rose in some places and the almighty competition between other MCOs did not lower costs – costs were actually raised and many people got worse care.

    I live in an area where we have a hospital system called "commonwealth health". It's a for-profit system and one of the worst systems in the entire nation. I don't understand how they could be such a terrible system if everything is for the profit motive?

    You also don't touch on a lot of major healthcare programs in America. You seemed to just maneuver your way around medicare and how you would insure the elderly. How you would change payment plans into that program. You also conveniently forgot to say anything about employer insurance. Let me guess. "If we get rid of employer insurance, we'll see those benefits trickle down to the worker in the form of higher take home pay." lol

    You also forgot to mention anything about the mind field that is pre-existing conditions in the healthcare system.

    So all we got from the heavyweight intellectual is "reduce regulations" (no regulations mentioned. We just need to cut LOTS), block grants that gives less money to the states for the poor and disabled (that's OK. People will get better care because of American ingenuity and exceptionalism), and paying another premium to go see a doctor – besides the premium you are going to pay for health insurance.

    Great job, Dan. Throw in a socialist in there and talk about how everyone on the left wants to destroy free enterprise and bring communism to America – it's what you are best at.

  5. Please interview with Doctors and Nurses at ER unit and OBG unit.
    Then you will see what the issue of treating non English speaker and non medical record.
    many many issue are there, please interview them.

  6. AKA "Healthcare works for the top 30% of the population without affecting their finances, why would we change it?" Shitty answer Dan

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