Freedom and Free Market say ‘No on 17’

Tomorrow, South Dakotans will go to the polls. Among the races and issues to be decided is one called Initiated Measure 17 which deals with the issue of in-network and out-of-network health care providers.

It is being billed by supporters as a “patient choice” measure, and I suppose that is true. But like so many pieces of legislation that get government involved in the free market, it actually takes away the choice of free market business owners.

Essentially, the measure would force insurers to accept any health care provider as “in network” as long as the patient wanted to utilize that health care provider, and as long as that health care provider is willing to agree to the insurer’s terms.

So everyone gets their choice here…except for the privately-owned insurer; as has become the growing trend in the growing-socialist America, the free market insurer gets to do what the government tells it to do.

Many supporters of Initiated Measure 17 will tell you that “government has already been meddling in the free market. I understand that government has already meddled. More meddling isn’t the right direction.

If this measure opened up competition across state lines (instead of the government protection racket we currently have), reduced government regulation or otherwise moved to reduce government health care schemes (e.g. Medicare, Medicaid, SCHIP, etc.), I could support it.

But having more of government telling one party that it must do business with another party, regardless of whether both parties agree to that relationship is just more tyranny and meddling in the free market.

More government meddling in the free market is the wrong direction for South Dakota, and the wrong direction for America.

Some supporters justify support for IM 17 on the claim that it would just negate Section 11, paragraph 3 of the 74 page of SB 38, a bill passed by the “Republican” legislature which even SB 38 supporters admit facilitated ObamaCare in South Dakota. The implication here is that we have in-network and out-of-network distinctions because of SB 38, and that because the language in SB 38 does not require insurers to work with specific providers, that repealing this section of SB 38 would in essence force insurers to enter into business agreements with health care providers whether they want to or not.

SB 38 says the act does not require health carriers to employ specific providers. But is there anything outside of this paragraph which would otherwise state or imply a requirement? If not, I can’t see how 17 would only apply to this one paragraph of SB 38. There were in-network and out-of-network coverage distinctions before SB 38, so 17 would seem to have much broader scope and applicability.

No, it does NOT restore the arrangement which existed before SB 38. SB 38 didn’t begin the system of “in-network” and “out-of-network” providers. As I pointed out before, designations of “in-network” and “out-of-network” existed long before SB 38.

I simply cannot reconcile government REQUIRING two private parties to do business with one another, to a free market or limited government principles. FORCING two private business entities to do business with one another is big-government tyranny.  If you own or owned your own business, would you like government telling you who you had to enter into business arrangements with?

Supporters also claim IM 17 should be viewed as the difference between medicine and the business of medicine.  But this issue isn’t simply the practice of medicine versus the business of medicine. You cannot separate the two..unless you’re going to opt for a fully socialized system (having lived under the military one for 10 years and the British one for three years, good Lord, no), you simply cannot pretend the business aspect is not there. And as long as doctors and medical providers are allowed (I hate to even use the word “allowed” in what SHOULD be a free country), to make a living by providing medical goods and services, the business and free market aspect cannot be ignored. Which means it is tyrannical for government to force a business (or individual, for that matter) to enter into a relationship it does not want. That is a simple matter of freedom. 

Freedom-the bedrock of free market and limited government principles-dictates that a person or persons cannot force another person to provide goods or services, or enter into relationships, against their will.

If someone doesn’t like the choices their insurance provider makes, they can change insurance providers, pay the out-of-network costs, or ditch their insurance and pay for 100% of their costs themselves.

But we don’t get to force private individuals and businesses to do what WE want simply because we disagree with them or we think they’re making too much money, etc. Sure, socialists do that, but America wasn’t founded on Marxist principles and isn’t supposed to run on that kind of tyrannical modus operandi.

Neither the medical providers or the insurers are interlopers into the relationship. The consumer seeks out a relationship with both. The consumer is certainly welcome to leave the insurer out of the relationship, but then they get to pay 100% of their medical costs themselves. Because they don’t want to do that, they invite the insurer into the relationship. And if you’re going to invite someone into a relationship to pay for part of the services you receive, it’s natural that certain stipulations come with that. You can agree to those stipulations, or you can not agree to them and pay 100% of your own medical costs. That’s called freedom.

What is an interloper into the process is government. And yes, some people have invited government into the entire process (going back to FRD), but in doing so, have robbed the rest of us of the choice of whether to involve them or not. 50 years or more of experience with government meddling, both in this country and around the world, should have taught us that any time we get government involved in the free market, we get higher prices, less efficiency, and less freedom for all.

And make no mistake: 17 most certainly does tell the insurer what to do: it tells them they MUST accept this or that medical provider, regardless of whether they want to or not, so long as the provider is willing to agree to the insurer’s compensation levels, etc. It tells the insurer they MUST accept (MUST means you, the business owner, don’t have the freedom to decide for yourself who you will associate with).

An insurer who doesn’t want to take on this or that medical provider is NOT obstructing patient choice. They patient ALWAYS retains the choice to go to this or that medical provider-they just have to pay more if the medical provider is out of network (or they could really free themselves of the insurer and pay 100% of their own cost). No one is obstructing ANY freedom of the consumer…but 17 would obstruct the freedom of a private business to control its own business practices, as well as its freedom to control its own associations.

Government has a legitimate role to protect people from acts of deliberate harm or fraud. There is no fraud in the in/out of network system. Everyone knows up front whether this or that medical provider is in or out of network, and the consumer has the freedom to choose whether to go to the out of network provider or not.

Leveraging government to MANDATE that the insurer enter into a relationship with the medical provider that they do not want to is by definition MORE government intrusion, less freedom, and in the end, simple tyranny (i.e. forcing your will upon a free entity).

Beyond even the issue of freedom and limited government (no small considerations, ever), there is the simple matter of whether this helps overall with health care costs. It doesn’t.

Sure, it will help a few individuals in the short term…but in embracing 17, supporters of 17 are shooting themselves in the foot in the long run.

Increasing the number of in network providers will without a doubt increase payouts from the insurers. Insurance companies will not allow those additional payouts to eat into their profit margin, or their bottom line. Higher operational costs virtually always get passed on to the consumer.

Therefore premiums will go up. So what you’re really saying is that you want your fellow policyholders to pay for your health care costs.

According to a 2006 analysis on state regulation of health care published by the Heritage Foundation:

In January 2005, Mark Showalter, William Con­gdon, and Amanda Kowalski published a working paper entitled “State Health Insurance Regulation and the Price of High-Deductible Policies.”[4] The authors used two separate datasets in their analysis. Golden Rule insurance provided 2003 insurance premium data from a series of random ZIP codes in 37 states, and eHealthInsurance.com, a major Internet broker of health insurance, provided pre­mium data from insurance policies sold through its Web site.

The authors focused on four types of regulations: (1) mandated health benefits, which require insur­ers to cover particular treatments or particular ser­vices; (2) “any willing provider” laws, which restrict insurers’ ability to exclude hospitals and doctors from their networks; (3) community rating laws, which require insurers to limit premium dif­ferences across individuals; and (4) guaranteed issue laws, which require insurers to sell insurance to all potential customers regardless of health or pre-existing conditions.

The authors found that each of these four types of regulations results in statistically significant increases in health insurance premiums. The find­ings were consistent across both the eHealthInsur­ance.com and Golden Rule datasets. The authors estimated that eliminating all of these regulations could save individuals up to $2,000 per year in insurance premiums.

And from another Heritage article in 2014:

The bargaining power of hospitals, and their ability to impose price increases, therefore depends on the ease with which insurers may omit them from their provider networks.[18] Their consolidation into multi-hospital systems, which bargain collectively with insurers across multiple markets, enables hospitals to make themselves harder to exclude—allowing them to command price increases twice the size.[19] Thus, the effectiveness of selective contracting in checking hospital cost growth has been blunted in highly concentrated hospital markets.[20] The ability of insurers to insist on good prices from hospitals has further been hobbled by “any willing provider” laws in the majority of states, which require insurers to reimburse any providers willing to accept the insurer’s rates, effectively limiting the ability of health maintenance organizations (HMOs) to divert patients to preferred hospitals.[21] The effect has been to reverse the slowdown in the growth of health care expenditures that had been achieved in previous years in areas with high HMO penetration.[22]

A better way of increasing health care accessibility and bringing down costs for EVERYONE (for individuals as well as the aggregate of health care spending) would be to propose a repeal of the government-backed “protection racket” which prohibits interstate competition and being able to buy/sell insurance plans across state lines.

This would bring more companies into the mix (increasing competition and thereby bringing premium prices down), and with more companies there would be more opportunities to purchase insurance where your favorite medical provider would be considered “in network,” thus lowering your personal health care costs.

That would (a) do something to really lower costs, (b) increase consumer choice, (c) maintain if not expand the freedom of insurers and health care providers, and (d) reduce the size and scope of government involvement in the free market.

17 invites still more government intrusion, and decades of experience should teach us: that is 100% the wrong way to go.

Many IM 17 supporters don’t like and don’t trust insurance companies and big health care providers. I don’t either. I understand that when certain dubious and rather untrustworthy people and groups are for or against something, it should cause us to stop and think. That is natural and wise.

But even a broken clock is right twice a day, and sometimes people or groups can have the right position, even if it’s for the wrong reason.

If a murderer were to assert that pedophilia was wrong, does the murderer’s past misbehavior automatically mean they are incorrect that pedophilia is wrong, and that because a murderer is against it, good people should be for it? Of course not. We cannot abandon logic and principle out of a knee-jerk reaction against people we don’t trust or like.

While large providers want to protect their profits and their right to make their own decisions (who among us wouldn’t, if it were OUR business in the crosshairs?), the fact remains that 17 is more government interference in the free market, another government mandate, and one more step away from limited government.

Sadly, some conservatives seem fixated more on who is against this measure (some large health care providers that no one really likes) and less on principles of limited government and the free market-you know, foundational principles that conservatives are supposed to consistently support. Some of these large health care providers (naturally) want to protect their profits, avoid still more government mandates, and avoid being forced into business relationships that are against their will.

I wonder if these conservatives owned or ran a business that some were trying to force a government mandate upon, would they be against the measure that would bring that new government mandate? I think we all know the answer to that.

Conservatives are supposed to be better than this. The Left has long been completely ruled by its emotions (the rank and file, at least). It has always been the conservatives who champion fact, logic, history and reason. We cannot abandon these tools or these principles simply because we don’t like the natural beneficiaries of limited government and the free market.We cannot embrace what we would otherwise condemn simply because we want to impose our will on a private business.

The Left justifies their big-government meddling on the basis that “it doesn’t harm the company’s bottom line” and “their current practices do not provide better care” and “the companies don’t care about their policy holders.” But apparently big government is okay as long as WE agree with it.

There is also a simple truth that should not be missed here: if you are okay with government meddling in free market health care in this case, then you have no justification whatsoever (beyond the constitutional jurisdiction issue on the part of the federal government) to complain about ObamaCare meddling. You cannot logically and consistently condemn government interference that you DON’T like while embracing government interference that you DO like. Both are intrusions into the freedom of a business to make its own decisions. Conservatives cannot convincingly argue that government is already too involved in health care if we are demanding yet another government requirement upon the health care industry.

When we stoop to leveraging the force of government to make a private business that we don’t own conduct its affairs the way WE see fit, we’ve stooped to the same kind of tyranny being promoted by the Left.

It almost seems as if there is an attitude which says the “little guy” is entitled to max freedom, but the perceived “big guy” is expected to sacrifice his freedom to give things to the “little guy.”

At what point does a person or business or entity get big enough that we, um, no longer have to be concerned with THEIR freedom?

Is it when it gets to be, say, the size of a bakery in Oregon? A bakery that doesn’t want to be forced to participate in the counterfeiting of marriage? Because the Left sanctions leveraging the power of government to force the business to enter into an association it does not desire, in the interest of providing “more consumer choice” to the “little guy” (as if they had no other choice).

Is it when they get to be the size of, say, Hobby Lobby? Because the Left argued that a “big company” should be forced to surrender its liberty and be forced to provide them with birth control, abortifacients, etc. In the interest of affording “more choice” for the “little guy.”

If affording “more choice” to the “little guy” at the expense of the liberty of a “bigger guy” is our standard of what is “right,” then we conservatives are no better than the Left. We’re just peddling a different brand of tyranny, more government oppression with a different label.

Either practices which violate limited government and free market principles are bad, or they aren’t. There’s a name for picking and choosing the unequal application of principles.

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