The interesting message from Mike Meyers’ Obamacare sales pitch, "What to do about the health care invincibles" (Jan. 5), is that the new Obamacare culprits are the young freeloaders. They have been found sabotaging Obamacare’s fiscal feasibility by not buying insurance or by not accepting some government insurance dole. Running a close second are “Republican saboteurs.”

The old culprits, doctors, were not mentioned.

So it seems Obamacare’s insurance mandate must be implemented to solve the problem presented by Meyers’ example of a 30-year-old hospital freeloader with an uninsured $35,000 bill for treatment of a broken ankle. Meyers suggests that more punitive schemes ought to be created to corral such bad un-insurance behavior.

Never asked is: Why does treating an ankle fracture cost $35,000? How is this high cost related to inflation of insurance premiums?

Uncontrolled medical cost-price inflation occurred abruptly after 1965, for the first time in nearly 100 years, a tipping point when 85 percent of the population (many employed workers and the officially old, disabled and poor) had suddenly acquired tax-free insurance benefits. Coverage expanded to include even expected minor expenses.

Demand skyrocketed with the appearance of this “free” prepaid care — “the boss or the government pays for it.” Inflation of insurance prices simply followed the increased demand for covered benefits. This American version of National Health Insurance systematically left out 15 percent of Americans — the only ones exposed to the real price of services and insurance.

Since the early 1970s, the nation has tried decades of managed-care cost-control gatekeeping through government price fixing and HMO barriers to care. However, rationing supply is futile when the basic problem is demand. The implicit Obamacare promise is that still more insurance coverage can make care affordable by spreading risk — an economic absurdity without renewal of unpopular and draconian 1990s-style rationing of supply.

Obamacare was sold as a means to politically control cost inflation as well as the means to close the insurance coverage gap by mandating that people buy insurance from the government’s new commercial insurance corporation partners. This cartellike partnership’s specious sales pitch was that doctors were the culprits behind inflation, driven to avaricious behavior by an evil fee-for-service system. The doctors’ avarice would be policed by the political partners, but it would be used to provide incentives for profitable bedside rationing of care in mini-HMO-like hospital “accountable care organizations” (ACOs).

These new corporate gatekeepers are intended to conserve society’s mandated premiums and tax monies in the hands of the mega-payer HMO corporations and government agencies.

The Obamacare fix transfers the gatekeeping role of corporate and government “payers” to ACO doctors at the bedside — another futile scheme, because doctors, no matter how motivated to restrict care, have no control from the bedside over politically subsidized insurance driving demand for “free” care.

Meanwhile, millions of people have had their insurance terminated, while access to mandated insurance networks that are more expensive and restricted is blocked by government website crashes.

As the Obamacare rollout stumbles, selling a more powerful political rationing system now includes feeble attempts to blame young freeloaders for looming threats to the program’s economic fantasy of fiscal feasibility through mandated “coverage.” Obamacare or not, many people cannot afford the inflated price of insurance to cover the inflated costs resulting from nearly five decades of tax-subsidized “free” care — like $35,000 ankle fractures.

Long ago P.J. O’Rourke said, “If you think health care is expensive now, wait until you see what it costs when it’s free.” There was and is a better way.


Robert W. Geist, a physician, lives in North Oaks.