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How a Grown-Up Health Care System Operates

How a Grown-Up Health Care System Operates

Update: 2025-12-23
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By Eric Hussey at Brownstone dot org.

In the theatrical musical version of Peter Pan, Peter leads the Neverland children in a song about (not) growing up. Toward the end of the song, Peter and the kids sing "We won't grow up! We will never grow a day! And if someone tries to make us…we will simply run away."

That strikes me as not wildly different from the attitudes of many Americans about "health care." Although, it's not about "health care" as such, it's about billing: who will pay for doctor visits, hospital visits, and medications. I suffered through a local professional association meeting not long ago and had to listen to a state senator talk about how his foremost goal legislatively is to assure "access" to "health care" for all in the State of Washington. He also let slip that Washington State is the "most highly leveraged" state in the Union for "health care." Then he went on to bemoan that the State of Washington doesn't have its own printing press to make money like the federal government does.

If you will allow me to do what some might call a "pirate translation" of the above, let me suggest that Washington State - I usually call it The People's Republic of Washington State - borrows more money per capita than any other state in the Union, from a federal government $37+ trillion in debt, to pay for doctor visits, hospital visits, and medications for whoever asks. The state bureaucracy to oversee this is paid for by ever-increasing taxes on the state population.

"Access" is not the correct word. Payment is the correct word. Well, actually, freedom from payment is the correct term.

Sometimes I hear a soon-to-become-former patient of mine - occasionally an already-former patient of mine - tell me how they hate it, but they can't come to see me any more since I don't take their insurance. No, that's incorrect. I assure you, you can come see me. But, because your insurance is a big pain in the neck for a single-doctor office like mine, I will not do the paperwork and take the discounts that they require to get any pay for my work. In fact, I will be happy to see you in my office. But, you will need to tell us how you will be paying for the visit.

To add some perspective to that, my independent one-doctor office has one-and-one-half full time people primarily billing insurance companies. Although three or four companies are involved, the majority of people in the State of Washington have some form of insurance through the State via one of those companies. That is, people who would never admit to this openly or even to themselves, are essentially on welfare with the State of Washington borrowing, keeping their insurance payments lower than they should be.

Which brings me back to Peter Pan.

I don't have any particularly embarrassing instances to share, but I have some vague recollections of my mother saying "Grow up!" after an errant behavior of mine. A great deal of growing up means you are taking responsibility for yourself and your actions. Does that include paying your way? If you are paying your way, you need to know how much something costs. When you are on welfare, that becomes irrelevant.

Ben Carson famously suggested his remedy for the "health care crisis" in 2013 at the National Prayer Breakfast. It took 43 seconds to deliver:

"We've already started down the path to solving one of the other big problems, health care. We need to have good health care for everybody. It's the most important thing that a person can have. Money means nothing. Titles mean nothing when you don't have your health. But we've got to figure out efficient ways to do it. We spend a lot of money on health care, twice as much per capita as anybody else in the world, and yet not very efficient. What can we do?

Here's my solution: When a person is born, give him a birth certificate, an electronic medical record, and a health savings account [HSA] to which money can be contributed, pre-tax, from the time you are born to the time you die. When y...
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How a Grown-Up Health Care System Operates

How a Grown-Up Health Care System Operates

Eric Hussey