Written by John Goodman
You know we have entered the silly season when a major national debate gets underway over whether people should be given something for free that they could easily pay for out-of-pocket. Take the decision of the Obama administration to force Catholic universities, hospitals and charities to provide health insurance that includes free contraceptives. The reaction was poignant and hyperbolic, but (what can I say?) completely deserved:
What makes this so amazing is that it is dÃ©jÃ vu all over again, as Yogi Berra might say. Do you remember the death knell for HillaryCare? I bet you can’t. Answer below the fold.
Mammograms and Pap smears. Hard to believe, isn’t it?
[Yes, I know. There were many things that helped derail HillaryCare. The biggest mistake was the White House's failure to throw everything aside and endorse the Senate Republican health plan, which was about as close to HillaryCare as RomneyCare is to ObamaCare. Hillary would have ended up with about 90% of everything she wanted. More about that, perhaps, in a future Alert.]
But what really killed the whole thing in the public’s mind were mammograms and Pap smears. Fifteen years ago the “experts” didn’t agree on how frequently women should have them any more than they agree today. I’m sure that when various women asked various doctors they got various answers. And, by the way, there is nothing wrong with that. Whenever there is risk and uncertainty, opinions will differ. That’s not the end of the world.
What was the end of HillaryCare, however, was the notion that the White House should decide these questions for every woman in America! When you stop to think about it, that takes a certain amount of chutzpah. It also reflects a degree of meddlesomeness that’s really hard for me to understand. But in both the Clinton White House and in the Obama White House there were folks who just could not abide the idea of your having a health plan different from the one they think you should have — down to the tiniest detail!
For Hillary and her advisers it came down to this: They decided that sexually active women should have a cervical cancer test every three years, instead of every two. For women in their fifties, they called for a mammogram every other year, instead of every year. And these decisions, unfortunately for Clinton, were different from what most doctors were recommending.
[The technical folks, by the way had fun with all of this. Cost-effectiveness numbers at the time suggested that Hillary’s cut-off number was about $100,000 for each year of life saved. If the projection comes in below that number, do the test. Above that number avoid it. Interested readers may consult my discussion of this issue here. I don’t think this facet of the problem ever got on anyone’s radar screen outside of the number crunching community; however, and I doubt that Hillary was even aware of it.]
Now the right way to think about all this is very simple. How much does a mammogram cost? $100? If you want one, take the money out of your Health Savings Account and go buy it. How often should you do that? Probably as often as it gives you peace of mind. Is not having the test keeping you awake at night? Then spend $100 and get the test. The same principle applies to contraceptives. You want them? Go buy them.
And what about the tiny, tiny, tiny portion of the population that really can’t afford these services? Go to a community health center or to Planned Parenthood and ask for them for free! This isn’t rocket science.
It is truly amazing how much consternation is caused for no other reason than the desire on the part of some people to tell everybody else how to live their live.
John C. Goodman is president and founder of the National Center for Policy Analysis, a free-market think tank located in Dallas, Texas. The Wall Street Journal and the National Journal, among other media, have called him the “Father of Health Savings Accounts.” Dr. Goodman’s health policy blog is the premier right-of-center health care blog on the Internet. It is the only place where pro-free enterprise, private sector solutions to health care problems are routinely examined and debated by top health policy experts across the ideological spectrum.