The Proper Principles of Health Care Reform
Arthur Astorino, Jr., MD
Peter LePort, MD
Cristina Rizza, MD
Most health care reform proposals offered today state that
"Universal Coverage" is a "principle" that will be used to solve the
problems in health care. However, this is not a principle, but a
goal. Every country that has implemented guaranteed medical
coverage has also instituted rationing to control costs. Moreover,
in each of these countries, whether England, Germany, Canada or
elsewhere, the quality of medical care has deteriorated while actual
access to it has decreased.
Our plan's overriding principle is respect for human life through
the protection of individual liberty. Its basic goal is to return
to the individual the right to decide how any money spent to provide
for his or her medical care will be spent. No individual or group,
whether a patient, a physician or a company, is forced to
participate against their wishes in any aspect of medical care. Only
such an approach, one based on the moral principles of individual
rights and personal responsibility, will allow free-market forces to
operate in medical care, thus providing universal access for all
Americans to the world's best medical care.
Most health care reform proposals recognize problems such as
increased costs, job lock, uninsurable individuals, etc. They don't
recognize their underlying causes, thus their solutions rely on
controls by bureaucracies. They believe health care spending is
determined by needs, as if it is independent of price, and therefore,
rely on panels of experts to determine all needs and set all prices
based on centrally determined costs.
AFCM, on the other hand, supports the position that health care
spending must be determined by choices among competing alternatives,
giving patients the power to choose between health care and other
uses of money. Most other proposals argue that individuals are not
smart enough or knowledgeable enough to make wise decisions when it
comes to choices in health care. AFCM admits that choosing a doctor
or treatment plan can be a complicated decision, however, it is more
complicated to vote for the right politician to select the right
bureaucrat to select the right doctors, hospitals and treatment
options for us.
In short, most proposals look to government for the solution and
empower the bureaucracy; AFCM looks to private citizens for the
solution and focuses on the decisions individuals make and the
incentives they face when they make them.
AFCM recognizes that the fundamental problem of American health care
today is government intervention. The government injects its power
to force people to do things that they would not choose to do on
their own, to influence transactions among patient, doctors,
hospitals, and insurance companies. The main ways government does
this are through: 1) tax laws that discriminate against individuals;
2) government medical care programs substituting for private charity
(see "Health Care Is Not a Right" by Leonard Peikoff;
and 3) restrictive licensing and regulations.
AFCM proposes the following solutions:
1. Tax policy without distortion: All medical-related expenses will
be equally tax-deductible for all individuals, as opposed to the
present system, which favors groups over individuals (see Milton
Friedman's article "The Folly of Buying Health Care at the Company
2. Individual ownership of health policy: Participation in any
health care plan will be freely chosen by the individual (not
compelled or encouraged by the government), so that the individual,
not the government or an employer, will typically own his own
policy. This will produce personal, portable, permanent and
actuarially fair insurance for medical catastrophes.
3. Health Savings Accounts: Individuals will be allowed to save
tax-deductible dollars in a tax-free account, which they control to pay for current and future medical expenses, including
medical insurance. This plan does not take away any of your current
choices. Indeed, HSAs broaden your choices. You may purchase any
insurance plan with your HSA, including private, HMO or PPO.
4. Privatization of all government programs: The principle of
Health Savings Accounts are applied to Medicare and Medicaid.
Eligibility for entering the programs are phased out over a 30-year
5. Revival of private charity through tax credits: During the
30-year phase-out of government medical programs, all charitable
dollar donations dedicated to health care will be tax credits to the
individual or entity making the donation. This will encourage
charitable organizations to devote portions of their time, effort
and means to medical needs. It will encourage hospitals to set up
charitable programs and physicians to do the same.
6. Liberalization of licensing and deregulation of all aspects of
medical care: We must first stop any further intrusion by government
into the market. Then we must start a process of deregulation. This
goal comes from the recognition that the individual patient, not
government bureaucrats, is the best person to decide who is or is
not qualified to provide their own medical services, the nature of
their own insurance policies, etc.
7. Malpractice reform: Medical malpractice judgments should be only
on the basis of negligence, not of poor outcome.
Under AFCM's plan for instituting free-market medical care, every
individual will have the opportunity to access health care without a
guarantee of coverage. All those presently made dependent on
government services will remain covered. Privatization of that
coverage will provide greater choice, quality and economy. Those
who have paid into the government system will have access to a
government system during the phase-out period. Those unable to obtain coverage through no fault of their
own during the phase-out period will have access to the HSA
program. A private charity program will be encouraged, so that all
those who cannot afford medical care once the free market has been
reinstated will be able to obtain it. Those who choose not to seek coverage for their future medical needs through the free market programs
will be free to do so with no risk to the rest of society; they only
risk having to rely on private charity, should a medical catastrophe
occur that they cannot afford. [No new laws are required to throw
them in jail, or fine them, for exercising their liberty to choose
not to be covered. Penalistic laws are required in all plans that
A plan based on the above values and objectives will give the
maximum security possible under any system of providing medical
care. It places the responsibility, control and incentives for
health care onto the individual. It allows the individual purchasing
decisions of millions of cost-conscious Americans to set the value
of the goods and services in medical care and medical insurance.
This is the brilliance of the American free-enterprise system. No
bureaucracy can replace the wisdom of the billions of medical
decisions made by individuals each year looking after their own
interest with their own resources.
AFCM's plan relies only on the free market, avoiding any government
controls and regulation. It gives free rein to individual genius,
ingenuity and entrepreneurship. It does not violate a single
individual's rights as defined under our Declaration of Independence
and Bill of Rights. Since 1776 America has set the standard for
freedom. At this time in history, the rest of the world is
recognizing its value. It is ironic that today some leaders in
America want to base our health care system on socialistic models
(e.g., single payer, employer mandates, community rating, "managed
competition," etc.) that are doomed to fail.
Failure of such plans is a result of their immorality in destroying
real individual rights. Only a plan such as AFCM's, based on the
American values of individual liberty, personal responsibility and
non-coercive free markets, can provide us with the best medical care
that the thought and effort of Americans can create.
Drs. Astorino, LePort and Rizza are physicians in private practice
and members of the Boad of Directors of Americans for Free Choice in
This article was published in the July 1994 print edition of
AFCM's newsletter, Pulse.
Copyright © 1994 Americans for Free Choice in Medicine. All rights reserved.
For reprint permission, contact AFCM.