The United States medical care crisis has been a long time coming.
In 1910, the physician oligopoly was started during the Republican administration of William Taft. The American Medical Association lobbied the states to strengthen the regulation of medical licensure and allow their state AMA offices to oversee the closure or merger of nearly half of medical schools and also the reduction of class sizes. Those restrictions remain in place today, severely curtailing the number of doctors who can enter the market because the bar is very high to get into medical school.
In 1925, prescription drug monopolies begun after the federal government (under Republican President Calvin Coolidge) started allowing the patenting of drugs, essentially creating monopolies.
In 1945, buyer monopolization begun after the McCarran-Ferguson Act led by the Roosevelt Administration exempted the business of medical insurance from most federal regulation, including antitrust laws. (States have also more recently contributed to the monopolization by requiring health care plans to meet standards for coverage.)
In 1946, institutional provider monopolization begun after favored hospitals received federal subsidies in the form of matching grants and loans provided under the Hospital Survey and Construction Act, passed during the Truman Administration.
In 1951, employers started to become the dominant third-party insurance buyer during the Truman Administration after the Internal Revenue Service declared group premiums tax-deductible.
In 1965, nationalization was started with a government buyer monopoly after the Johnson Administration-led passage of Medicare and Medicaid which provided government-provided health insurance for the elderly and poor, respectively.
In 1972, institutional provider monopolization was strengthened after the Nixon Administration restricted the supply of hospitals by requiring federal certificates-of-need for the construction of medical facilities.
In 1974, buyer monopolization was strengthened during the Nixon Administration after the Employee Retirement Income Security Act exempted employee health benefit plans offered by large employers (e.g., HMOs) from state regulations and lawsuits (e.g., brought by people denied coverage).
In 1984, prescription drug monopolies were strengthened during the Reagan Administration after the Drug Price Competition and Patent Term Restoration Act permitted the extension of patents beyond 20 years. The government has also allowed pharmaceuticals companies to bribe physicians to prescribe more expensive drugs.
In 2003, prescription drug monopolies were strengthened during the Bush Administration after the Medicare Prescription Drug, Improvement, and Modernization Act provided subsidies to the elderly for drugs.
In 2014, nationalization was further strengthened after the Patient Protection and Affordable Care Act of 2010 (“Obamacare”) provided mandates, subsidies and insurance exchanges, and the expansion of Medicaid.
With each new law or set of new regulations, restrictions on the medical care market went further, until, at some point in the 1980s, people began to notice the cost of medical care had skyrocketed … soon to be followed by the cost of medical insurance.
As regulators allowed special interests to help design policy, everything from medical education to drugs became dominated by virtual monopolies that wouldn’t have existed if not for government’s notion that intervening in people’s lives is part of their job.
We started meddling in 1910, but costs didn’t go up immediately and that causes a lot of short-sighted people to think the regulation is not related to the increased costs. They’re wrong, but some regulation was more harmful than other regulation.
In 1972 President Nixon restricted the supply of hospitals and clinics by requiring institutions to provide a certificate-of-need, then in 1974, the president strengthened unions for hospital workers by boosting pension protections, which increased the cost for hospitals. This move began to force doctors who once owned and ran their own hospitals to merge into provider monopolies. These, in turn, are often only able to keep their doors open with the help of government subsidies, so increasing costs to taxpayers..
As the number of hospitals and clinics became further restricted and the medical care industry became obsessed with simple compliance, patients were the first to feel abandoned. According to Business Insider, the average doctor has thousands of patients, and each visit lasts less than 30 minutes. As many in my parents’ generation can attest, doctors listened to their patients prior to the government’s slow but absolute control of medical care, doctors listened to the patients and medical care was easily affordable. Now, doctors can hardly recall the conversations they have with the people they are supposed to be looking after.
Insurance is not the same thing as medical care, but President Barack Obama pushed further restrictions on the insurance industry by touting the Affordable Care Act as a piece of legislation that would make insurance more affordable. That didn’t work out. Insurance had already been increasingly slowly over the years, but since the passage of the ACA, there’s been an average increase of 153% in premiums. And as a result, a new group of independent medical care professionals ignited one of the most liberating revolutions in recent U.S. history. As ACA became increasingly suffocating to patients and providers, many doctors ditched the system altogether while others went into the primary care business.
On average, members of these direct primary care clinics pay as little as $60 per month, with couples paying about $150, which is a lot less than the cost of full medical insurance. Without having to handle heavily regulated middlemen, patients have a clearer picture of how much they spend on their health by being members of such practices. They also enjoy the peace of mind of knowing their doctor.
Studies have already demonstrated that when there is good communication between doctors and patients, treatments are more efficient. This is not simply because doctors are giving patients attention, but also because they are able to tailor a certain treatment to that patient’s lifestyle, health, and activities.
What many people don’t understand about government-run medical care is that government bureaucrats apply a one-size-fits-all mentality to everything, but what bureaucrats fail to understand is that they do not possess all the answers. Only a doctor who is paying attention will be better able to help the individual patient. Those needs cannot be addressed by a few thousand new regulations under either the ACA or the AHCA.
What this growing movement seems to suggest is that, even if doctors and patients are unaware of the interventionist forces driving the cost of doing business and receiving medical attention, they’re still driven into the open arms of the free market at some point or another.