Columbia International Affairs Online: Journals

CIAO DATE: 07/2010

How to Protect Yourself Against ObamaCare

The Objective Standard †

A publication of:
The Objective Standard

Volume: 5, Issue: 2 (Summer 2010)

Paul Hsieh


Full Text

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (known colloquially as "ObamaCare"), declaring that the law would enshrine "the core principle that everybody should have some basic security when it comes to their health care."1 But, for reasons I have elaborated in previous articles in TOS, far from establishing security regarding Americans' health care, this new law will make quality health care harder to come by and more expensive for everyone. Unfortunately, until our politicians rediscover the principle of individual rights, choose to uphold it, and reverse this monstrosity of a law, we Americans are stuck with it and will have to cope the best we can.

So, what can you do in this new era of "change" to preserve your access to quality health care?

Although it is impossible to avoid the harmful effects of ObamaCare entirely, if you plan wisely and act accordingly you can minimize its effects on you and maximize your chances of receiving quality health care in the future. Toward that end, I offer the following four strategies, two of which pertain directly to your personal arrangements for health care, and two of which pertain to intellectual and political activism. (Some of this material is adapted with permission from an essay by Christian Wernstedt, who lived under the Swedish socialized medical system before he moved to the United States.)2
1) To the extent possible, arrange to pay for your medical care directly rather than through an insurance policy.

As ObamaCare is phased in, doctors who provide health care paid for by insurance companies will be under increasing pressure to practice according to government "cost effectiveness" and "quality" guidelines-guidelines that will, in many cases, reward doctors for withholding care from patients.3 Importantly, these guidelines will not only affect patients covered by government health-insurance programs such as Medicare and Medicaid; they will also affect patients with private insurance-because, under ObamaCare, even private policies must meet the approval of the government. As former New York lieutenant governor Betsy McCaughey explains:

[ObamaCare] makes you enroll in a [government-approved] plan and then says that only doctors who do what the government dictates can be paid by your plan.

"Qualified plans" can contract only with a doctor who "implements such mechanisms to improve health-care quality as the [current or future] secretary [of Health and Human Services] may by regulation require" (Sec. 1311, pp. 148-49). That covers all of medicine, from heart care to child birth, stents to mammograms.4

Because the combination of mandatory insurance and government cost-effectiveness guidelines will pressure physicians to compromise on their patients' health care, you can best avoid such compromise by contracting with physicians directly rather than through an insurance company. By paying directly, you will enable your doctor to practice according to his best judgment rather than according to the government's "cost-effectiveness" guidelines.5 Keeping insurance companies out of the picture keeps the government at bay, which enables your doctor to be your doctor. An added benefit to this approach is that many physicians' offices offer patients a discount if they pay directly for services when rendered.

Some doctors, such as Dr. Brian Forrest of Apex, North Carolina, now refuse insurance payments altogether and accept direct payments only. By eschewing the insurance system, Dr. Forrest is able to spend more time with his patients, provide them with quality care, and lower their medical costs.6
Health Savings Accounts

To make paying directly even more financially efficient, consider opening a Health Savings Account (if your state permits it). A Health Savings Account (HSA) is a special, tax-free savings account into which you deposit money to be used for medical expenses (and, by law, only for medical expenses). HSA funds are typically used for routine and predictable medical expenses, such as eyeglasses, vaccinations, and well-baby checks. Combined with a high-deductible, catastrophic insurance policy (to cover unexpected, expensive medical problems, such as a major accident or illness) an HSA enables you to pay doctors directly with tax-free dollars, while any unspent funds accumulate interest. This provides incentive to spend prudently and save for the future.

Unfortunately, because HSAs enable people to partially opt out of the government-controlled insurance system, many politicians seek to outlaw them.7 As of this writing, the fate of HSAs under ObamaCare is still unknown.8
Concierge Medicine

Another direct-pay possibility is concierge medicine. A concierge physician is a doctor who works directly for you via a retainer fee. In exchange for the retainer, concierge physicians offer certain guaranteed benefits and services, such as 24-hour telephone access and personalized consultations to discuss complex medical questions, preventive care plans, test results, and treatment options. And, in the event that you ever require hospital admission for a serious illness, a concierge physician even coordinates your care with specialists based on his detailed knowledge of your full medical history. This can be a huge boon, especially in this new era of "change." As concierge physician Dr. Steven Knope explains:

Concierge doctors . . . serve the important role of patient advocate during a medical crisis, helping people negotiate through our broken medical system when they become ill. When necessary, they can find the best specialists to meet your needs. At 2 o'clock in the morning when you develop chest pain, there is a familiar voice at the end of the telephone. The concierge physician also becomes the captain of your medical ship, providing continuity of care, from the office, to the hospital, to the medical intensive care unit, to your home. In short, the concierge physician is a modern-day Marcus Welby.9

Concierge medicine may sound expensive, and it can be, but it is not necessarily too expensive for the average American. As Dr. Knope notes, "Many forms of concierge medicine cost around $150 per month, which is the price of a package of cigarettes per day, or a daily cup of Starbuck's Frappuccino. . . . The cost of concierge medicine depends upon the services that are offered by the individual doctor. Costs range from $1,500 per year to $15,000 per year."10
Medical Tourism

Finally, if you require particularly complicated or expensive medical care, you may also wish to consider "medical tourism," the practice of traveling to other countries to purchase medical treatments free from U.S. restrictions. Medical tourism destinations are typically modern facilities staffed by American-trained English-speaking physicians offering services specifically designed to attract foreign patients. Medical tourism advocates claim that patients can receive quality care comparable to that in American hospitals, but at a lower price.11 Regarding the issue of quality, one must, of course, perform due diligence. But there is no question that the cost savings can be significant. Hip surgery that might cost $40,000 in the United States could cost between $6,000 to $15,000 elsewhere. Surgery to correct a deviated septum in the nose might cost more than $10,000 in the United States, but less than $4,000 overseas (including travel and lodging in a luxury resort).12

The foregoing are just a few ways to pay your doctor directly and thus keep the government out of the way. Granted, paying your doctor directly may ultimately mean paying twice for health care: first in the form of mandatory insurance, which you do not use, and second in the form of the fee paid directly for private care. And being forced to pay for a service you do not even use is doubly unjust. (This, incidentally, is the same kind of double payment with which parents of private-school students are saddled.) But within the context of our now substantially socialized health-care system, direct pay may be your best option.
2) Assume full responsibility for your personal health.

Each individual's health is, of course, his own responsibility, and various "dos" and "don'ts" always follow from this fact. Under ObamaCare, however, certain "dos" and "don'ts" follow emphatically.
Eat Well and Exercise Regularly

The most basic actions you can take toward getting and staying healthy are eating well and exercising regularly. By becoming or remaining healthfully lean and fit, you can avoid many medical problems in the first place. It is beyond the scope of this article to make specific dietary and exercise recommendations, but I do recommend reading the major thinkers in these areas and deciding what makes the most sense to you. The time you spend performing such due diligence will be well worth the vital knowledge you gain thereby.
Treat Government-affiliated Health Recommendations with Extra Caution

Of course, you should never accept any health recommendation at face value; even recommendations from your own trusted doctor should make rational sense to you before you follow them. But recommendations created by, sanctioned by, or even affiliated with government bureaucrats are in a different category from those offered by personal physicians who have actually studied medicine, who have taken an oath to practice in their patients' best interest, who seek to profit by providing excellent care, and whose reputations are crucial to their business success.

Bureaucrats and politicians do not possess the medical expertise of doctors. Nor do they have the professional incentives that doctors have to provide patients with the medical advice and care appropriate for their particular circumstances. Bureaucrats and politicians have incentive only to cut costs for the government, and their recommendations frequently reflect this fact.

Consider, for instance, the screening mammography guidelines recently issued by the U.S. Preventive Services Task Force. The USPSTF recommended restricting screening mammograms to women over age fifty, even though professional medical societies such as the American Cancer Society and American College of Radiology-based on many years of peer-reviewed medical research-have long recommended that women undergo routine mammography starting at age forty.13 The USPSTF openly acknowledges that if women followed its recommendation, the result would be an additional death per nineteen hundred women not screened; but the bureaucrats consider this acceptable because it would be "cost effective."14

Even advice from nominally private groups, such as insurance companies or medical specialty societies, may become corrupted as the government increasingly pressures those groups to toe the government line. When private insurance companies depend on government approval for their economic survival, they are less likely to promote health advice that diverges from government recommendations. And when the government dictates how much and when specialists may be paid for their services, even medical specialty organizations such as the American Cancer Society may be less likely to dissent from irrational government guidelines.

The government's health guidelines are formulated not for the purpose of serving the best interests of patients, but rather for the purpose of controlling costs for the government. Do not uncritically rely on them. Perform due diligence, consult the most objective, nongovernment-affiliated experts you can find, and rely on your own judgment.
3) In your own thinking, and in conversations with others, place the blame for America's health-care problems where it properly belongs: on bad government policies and on those who have advocated them.

The current American health-care crisis was created by decades of government intervention; thus, the blame belongs squarely on that government intervention and on those who have advocated it.

Americans who follow the news received ample warning of the problems we can expect under ObamaCare. A mandatory health-insurance scheme similar to the one included under ObamaCare was implemented with much fanfare in Massachusetts in 2006, and it led quickly to numerous problems-including skyrocketing costs, longer waits for medical care, and a fiscal crisis for the state government.15 Granted, many liberals (and some conservatives) have claimed that these problems "proved" that there were insufficient government controls; they have blamed the highly regulated residual free-market elements of the Massachusetts plan; and they have proposed as a "solution" a complete government takeover of health care in the form of a "single-payer" system.16 But the problems were clearly caused by the government controls, and the only viable solution is to repeal those controls and implement genuine free-market reforms.17 (For elaboration on this point, see my article "Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America," TOS, Fall 2008.)

Because ObamaCare is based on the same flawed ideas as the Massachusetts plan, a similar debate is certain to erupt when similar problems of rising costs and reduced access to medical services develop under ObamaCare. Advocates of freedom and quality health care must not allow ObamaCare supporters to spin the truth or avoid responsibility for problems they created. Just as a free market in health care did not and does not exist under RomneyCare in Massachusetts and thus cannot be the cause of that state's health-care problems, so a free market in health care does not exist under ObamaCare in America and thus cannot be blamed for the coming problems. As George Mason University professor Peter Boettke notes:

If you bound the arms and legs of gold-medal swimmer Michael Phelps, weighed him down with chains, threw him in a pool and he sank, you wouldn't call it a "failure of swimming." So, when markets have been weighted down by . . . regulation, why call this a "failure of capitalism"?18

Boettke's succinct and accurate analogy is worth bearing in mind for the coming debate-the outcome of which will determine the future of health care in this country.

We who care about American health care must not allow liberals (or conservatives) to portray the coming failures of ObamaCare as failures of the free market. These failures will be failures of further government controls imposed on the health-care market, and that is how we must identify them.
4) Advocate the repeal of ObamaCare and the implementation of free-market reforms in health care.

Many Americans assume that once a government program has been created, it can never be repealed. But this assumption is false. Laws of Congress are not laws of nature; any law passed by Congress can also be repealed by Congress. Observe that Prohibition was passed with overwhelming political and popular support in 1919-then repealed in 1933. Repealing ObamaCare may be difficult, but it is not impossible.

If Republicans regain control of Congress, they can and should repeal ObamaCare-and Americans concerned about their future health care must demand that Republican politicians openly commit to doing so. As former U.S. Senator Phil Gramm eloquently wrote in the Wall Street Journal:

Republicans have a job to do. They must make it clear to the American people that this is only the beginning of the debate. There will be two congressional elections and a presidential election before the government takeover is implemented in 2014. . . .

Republicans should take the unequivocal position that if they are given a majority in Congress in November, they will stop the implementation of the government takeover. And if a Republican is elected president in 2012, they will do with Mr. Obama's health-care bill what the American voters will have done to the Democrats: throw it out.19

This is sound advice for Republicans. But repealing one bad law will not be enough. If Republicans want to return American health care to the healthy, thriving industry that it can and should be, they must work to repeal all of the rights-violating laws that thwart Americans' freedom to contract according to their own best judgment: laws against purchasing insurance across state lines; restrictions on Health Savings Accounts; prohibitions on the sale of inexpensive, catastrophic-only policies; laws that force insurers to offer (and patients to purchase) unwanted benefits; and so on. Republicans should also equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.20 These and other such reforms, by respecting individual rights, would greatly reduce health-insurance costs and increase accessibility for Americans.

In closing, let me stress that the above recommendations presuppose and depend on the principle that it is morally right for individuals to act on their own best judgment for their own best interest. Thus, at the personal level, enacting these strategies requires recognizing that each individual ought to promote his personal health and well-being. At the political level, it requires recognizing that each individual has a moral right to act and contract according to his judgment, without government interference.

The first round of the political battle over health care has gone to those who would violate this basic right. But if Americans speak out and demand politicians and a government that respect our individual rights, the final victory can still be ours.


1 Sheryl Gay Stolberg and Robert Pear, "Obama Signs Health Care Overhaul Bill, With a Flourish," New York Times, March 23, 2010.

2 Christian Wernstedt, "Guidelines For Survival Under Socialized Medicine," We Stand FIRM blog, November 10, 2009; accessed at

3 Martin Feldstein, "ObamaCare Is All About Rationing," Wall Street Journal, August 18, 2009.

4 Betsy McCaughey, "ObamaCare vs. the Constitution," New York Post, January 6, 2010.

5 Ari Armstrong, "Health and the Empowerment of Payment," blog, October 2, 2009, accessed at

6 Morgan Lewis Jr., "How to Run a Cash-Only Practice and Thrive," Modern Medicine, January 22, 2010, accessed at

7 "The End of HSAs," Wall Street Journal, November 23, 2009.

8 "ObamaCare Survivor," Investor's Business Daily, March 30, 2010.

9 Steven Knope, "What is Concierge Medicine?" accessed at

10 Steven Knope, "The Six Myths of Concierge Medicine," accessed at

11 cf. Walecia Conrad, "Going Abroad to Find Affordable Health Care," New York Times, March 20, 2009.

12 Julie Davidow, "Cost-saving Surgery Lures ‘Medical Tourists' Abroad," Seattle Post-Intelligencer, July 24, 2006.

13 Rob Stein, "Breast Exam Guidelines Now Call for Less Testing," Washington Post, November 17, 2009; "Can Breast Cancer Be Found Early?" American Cancer Society, September 19, 2009, accessed at; Wendie Berg et al., "Frequently Asked Questions about Mammography and the USPSTF Recommendations: A Guide for Practitioners," Society of Breast Imaging, December 11, 2009, accessed at

14 "American Cancer Society Responds to Changes to USPSTF Mammography Guidelines," November 16, 2009, accessed at

15 Paul Hsieh, "Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America," The Objective Standard, Fall 2008.

16 Steffie Woolhandler and David U. Himmelstein, "Health Reform Failure," Boston Globe, September 17, 2007.

17 Paul Hsieh, "Health Care in Massachusetts: A Warning for America," Christian Science Monitor, September 30, 2009; Michael Tanner, "Massachusetts Miracle or Massachusetts Miserable: What the Failure of the "Massachusetts Model" Tells Us about Health Care Reform," Cato Briefing Paper no. 112, June 9, 2009.

18 Eamonn Butler, "Believers in Free Markets Are Fighting Back," Times, March 9, 2009.

19 Phil Gramm, "Resistance is Not Futile," Wall Street Journal, March 25, 2010.

20 John Mackey, "The Whole Foods Alternative to ObamaCare," Wall Street Journal, August 11, 2009.