The rising cost of health care is driving more and more citizens into Medicaid, the program for the poor. Medicaid, in turn, drives up the cost of health care by under-paying doctors. HealthAffairs.org says that it doesn’t even pay half of the discount price that your insurance company would pay. A survey of thousands of physicians, by CNN, reveals that Medicaid only covers 50% – 70% of their costs of providing care.

Forcing a doctor to work for free is unethical;  forcing him to pay from his own pocket to work is STEALING.  Little more than half  (55%) of primary-care physicians in California now accept new patients from that state’s Medicaid program, Medi-Cal, according to a recent study from the California Health Foundation.  The shortage of available doctors has caused emergency-room visits by Medi-Cal patients to surge by 75% in the past five years, and that pushes up the cost of hospital care for the general population—and causes a shortage of beds in the ER.

Any health care organization that loses money on a third of its patients will—obviously—have to overcharge other patients to break even.  Every expansion of Medicaid causes an increase in the cost of health care for everybody else.

Medicaid now covers more people than the British National Health Service.  Different states have different rules;  the FAQs for the NH Health Protection Program, our expanded Medicaid program, says that assets—such as “money in the bank”—are “not considered when determining eligibility” (https://www.dhhs.nh.gov/ombp/nhhpp/documents/faq-nhhpp.pdf , FAQ #9).   New Hampshire schools also receive significant funds from Medicaid, to pay for the aides who work with handicapped children.

The Affordable Care Act exchanges cover 3.7% of Americans, and the VA covers 2.8%.  Medicare covers 17%, and Medicaid has grown to 74.5 million, or 23% of Americans.  So 46.5%, or nearly half of our population, is covered by some form of socialized medicine.  Gallup says that 11.7% of Americans, 36 million people, still don’t have health insurance.

It’s not as if a policy of swindling doctors is going to balance the budgets of Medicare and Medicaid.  Together the two programs now consume more than a trillion of the $3.3 trillion that the federal government raises each year in taxes, and they’ve nearly doubled since 2006.   The United States spends a bigger part of its GDP on publicly-financed healthcare than Spain does.  We spend more on government healthcare as France and Germany, each of which has a surprisingly-large, competitive, free-market health care sector.

Health care is now unaffordable, for most Americans, without subsidies from business or government.  If we don’t find a way to get costs down, we won’t be able to stop the galloping growth of the federal debt.  Our children will pull the plug on Medicare and Medicaid, because they won’t have any other reasonable choice.

“Cash based” medicine, and its startlingly-low prices, offer the chance for a better future.  MDsave.com offers the names of hospitals willing to perform surgery at very low prices, as long as they don’t have to deal with insurance companies or the government.  The hospitals are bidding against each other, so over time these prices will decline as the cost of medicine elsewhere rises.  http://www.dpcfrontier.com/ offers the names of individual doctors who provide care for a low monthly fee.  If you search on the map provided you’ll find a number of practitioners with impressive resumes offering substantial service at very low cost.

Low Cost Insurance Can Be Available to Everyone.  Those who are pushing for a single payer system—they want to put everybody into the Veterans Administration—dismiss this wonderful new world as “concierge medicine” that’s only available to the wealthy.  That dark view can’t be reconciled with the comprehensive primary care offered by many of the DPC Frontier doctors for just $79 a month, and the all-in prices for 250 surgical procedures offered by the Surgical Center of Oklahoma on its website for all to see.

If you’re interested in health care insurance instead of health care, it’s absolutely possible for insurers to offer inexpensive care in this way.  The lower costs can be made available to everyone, at low cost, if we persuade insurance companies to offer insurance based on the prices that are listed online for surgery and hospital care.  In this form of insurance a patient needing surgery would receive a check for the clearly-posted price, just as victims of auto accidents receive checks from auto insurers for injuries and fender damage.

This sort of health insurance would cost far less than half as much as the bureaucracy-heavy, anti-competitive health insurance we have today.  And if lots of people shop for their care, prices will decline.

A patient receiving a check from her health insurer might be able to keep part of it if she shops carefully.   If she’d rather go to Mass General, she can simply re-mortgage the house and go.


“In Singapore almost everyone has to pay something for their [health] care. When it’s your money, you really ask yourself: Do I really need this?”

– Dr. Jason Yap, Director of marketing for a large hospital in Singapore. Singapore spends only 4% of its GDP on health care (the U.S. spends 17%                                   of GDP), but Singaporeans have a greater life expectancy than Americans. And their infant mortality rate is lower.