Last week the congressional Joint Economic committee on which I serve held a hearing featuring two courageous medical doctors. I had the pleasure of meeting with one of the witnesses, Dr. Robert Berry, who opened a low-cost health clinic in rural Tennessee. His clinic does not accept insurance, Medicare, or Medicaid, which allows Dr. Berry to treat patients without interference from third-party government bureaucrats or HMO administrators. In other words, Dr. Berry practices medicine as most doctors did 40 years ago, when patients paid cash for ordinary services and had inexpensive catastrophic insurance for serious injuries or illnesses. As a result, Dr. Berry and his patients decide for themselves what treatment is appropriate.

Freed from HMO and government bureaucracy, Dr. Berry can focus on medicine rather than billing. Operating on a cash basis lowers his overhead considerably, allowing him to charge much lower prices than other doctors. He often charges just $35 for routine maladies, which is not much more than one’s insurance co-pay in other offices. His affordable prices enable low-income patients to see him before minor problems become serious, and unlike most doctors, Dr. Berry sees patients the same day on a walk-in basis. Yet beyond his low prices and quick appointments, Dr. Berry provides patients with excellent medical care.

While many liberals talk endlessly about medical care for the poor, Dr. Berry actually helps uninsured people every day. His patients are largely low-income working people, who cannot afford health insurance but don’t necessarily qualify for state assistance. Some of his uninsured patients have been forced to visit hospital emergency rooms for non-emergency treatment because no doctor would see them. Others disliked the long waits and inferior treatment they endured at government clinics. For many of his patients, Dr. Berry’s clinic has been a godsend.

Dr. Berry’s experience illustrates the benefits of eliminating the middleman in health care. For decades, the U.S. healthcare system was the envy of the entire world. Not coincidentally, there was far less government involvement in medicine during this time. America had the finest doctors and hospitals, patients enjoyed high quality, affordable medical care, and thousands of private charities provided health services for the poor. Doctors focused on treating patients, without the red tape and threat of lawsuits that plague the profession today. Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs down, as the patient was directly responsible for payment, rather than an HMO or government program.

We should remember that HMOs did not arise because of free-market demand, but rather because of government mandates. The HMO Act of 1973 requires all but the smallest employers to offer their employees HMO coverage, and the tax code allows businesses – but not individuals – to deduct the cost of health insurance premiums. The result is the illogical coupling of employment and health insurance, which often leaves the unemployed without needed catastrophic coverage.

While many in Congress are happy to criticize HMOs today, the public never hears how the present system was imposed upon the American people by federal law. In fact, one very prominent Senator now attacking HMOs is on record in the 1970s lauding them. As usual, government intervention in the private market failed to deliver the promised benefits and caused unintended consequences, but Congress never blames itself for the problems created by bad laws. Instead, we are told more government – in the form of “universal coverage” – is the answer.

We can hardly expect more government to cure our current health care woes. As with all goods and services, medical care is best delivered by the free market, with competition and financial incentives keeping costs down. When patients spend their own money for health care, they have a direct incentive to negotiate lower costs with their doctor. When government controls health care, all cost incentives are lost. Dr. Berry and others like him may one day be seen as consumer heroes who challenged the third-party health care system and resisted the trend toward socialized medicine in America.

May 5, 2004

Dr. Ron Paul is a Republican member of Congress from Texas.