By Mark David Blum, Esq.
We are now in the midst of a great civil debate. What was once thought of being a politically dead third rail (aka Hillarycare), is now hotly under scrutiny and discussion in all quarters of society. Nowhere more important is the discussion of universal healthcare than presently in the United States Congress. Currently enjoying their August recess, our federal legislature has taken the case for universal healthcare from Washington D.C. and is trotting it out for public discussion at every hamlet Middlesex and farm; with the one notable exception being Sen. Diane Feinstein’s Los Angeles offices where staffers had police remove a gaggle of senior citizens wishing to discuss the issue with the Senator.
I wanted to take a moment of your otherwise busy schedule to respond to some of the non issues clouding the discussion so that when your turn comes, you will not be blinded to some of the realities of the situation we are all facing.
First and foremost, I strenuously object to hearing about “government run” health care as if a federal bureaucracy is a wholly inefficient model to deliver a product known as health care and medical treatment. To those who posit this federal model as a danger, corrupt, or inefficient I respectfully submit the Veterans Administration, the Medicaid Administration, and the Social Security Administration. Each delivers a quality of health care that we demand and our elected ones fund. Surely and without debate there is waste in each operation and pieces of each could be run more efficiently. Still, the VA provides medical treatment to anybody who is a veteran and who walks in its doors. Medicaid sends a check for each person over age 65. All agencies deliver their product for a portion of what the private sector charges and costs. Medicaid overhead is approximately two percent of operations. Private insurance companies have a twenty to thirty percent overhead. Veterans health care, according to the most bloodthirsty Republican is the best health care available and should be made available as partial compensation for service to one’s country. At its core however is that each agency is proof positive that the government can run a health care operation and run an insurance program and do so more efficiently and for far less cost than the private sector.
Secondly, I am always greatly amused when I hear about how private insurance companies would not be able to compete with a publicly funded health care program. Too bad, say I. Imagine shutting down Henry Ford and his factories because his new invention and the mass production means he developed because we saw a threat such mass production of automobiles would have upon an entire industry of blacksmiths, liveries, and stables. There is a fundamental flaw in any logic that says we should not try a program because we can do so for less cost and more efficiently simply because of the negative blowback it might have upon an industry which is no longer of value to a large segment of society.
Third, I stand wholly against the proposition that health coverage should be delivered through private sector employment. Our nation’s employers are not medical providers (unless that is their service). Companies sell widgets and the skills to build, install, and operate those widgets. The last thing employers need is to involve themselves in the business of insurance; either in carrying it and billing for it, or in paying monstrous premiums to commercial carriers. It simply is not their business and frankly, they are incompetent at providing any quality benefits for the prices charged. Employment-based insurance gives the employer unbelievable access to the most private aspects of a person’s life. Employers will know your blood pressure, your drug preferences, and of your venereal diseases. You will have to share personal medical information just to get the job; not because it is a condition of employment but because it is necessary to assess your impact upon their risk pool. Prior to the Second World War, there was no concept of an employer driven health care system. Because millions of healthy workers were in uniform, current demands of industry were high, and the labor force controlled the market, employers began using Health Insurance as an added incentive to lure skilled workers to their industry. That behavior has never changed. When the next generations came into the work force, they too wanted the same benefits as their forefathers and what we have ended up with today is a benefit that is on par with actual salary as the primary job consideration.
Likewise, I was shocked to learn that medical insurance as a benefit of employment is not considered “income” and thus not taxed as part of a person’s income. With health care plan premiums being about $1,100.00 per month for a family plan, it cannot be said that payment of that premium is not income. While I begrudge nobody their insurance, I still feel that they should contribute a fair share of their income. I do not have the legal right to deduct from my taxes the full value of any privately funded family health insurance plan. Fair is fair and if I have to pay taxes on my insurance, so too should you.
One aspect our current discussion of universal health coverage is the right of the citizen to self insure. While a person can choose to partake of Cadillac insurance, another person should have the right to build their own motor vehicle. Here I argue that a person should be able to have their own tax free health savings accounts. Presently, the government does permit some form of HSA but requires that they be funded through an employer and be accompanied by a catastrophic health insurance plan. Instead, we should have HSAs that can be funded by a person, be free of any judgment – public or private, contributions should be tax free provided the money is used for medical treatment, and the best part is that if a person does not deplete the account, there should be a right of inheritance of any unused portion. If I buy a major medical policy with a million dollars worth of coverage and I only use half the million, my survivors get no benefit.
The bottom line in any health care discussion is starting from the premise that we need universal coverage. Not just children deserve our attention. Nor should we only award the elderly and the unionized. Every citizen deserves medical coverage and having access to medical coverage is a basic human right.
If you are standing on a corner and are robbed, you have a socialized police force ready to come to your help. You have a socialized criminal justice system and prison system to deal with threats and wrongdoers. We do this because we realize that at any given time, any one of us could be a victim of a crime and need help.
If your house is burning down, again we have a socialized fire rescue agency to come and help. Again, we do this because we all realize that any one of us could be at risk of fire and we provide this service to all for our own protection.
If your child cannot read, then we have a socialized educational system because we all realize the value of an education and how it betters the nation.
If we need plumbing, roads, plowing of snow, we have socialized infrastructure to help everyone because we realize that as a community we need to be able to move about.
But, if you are standing on a corner and you see a fellow American drop to the ground suffering from a heart attack, all we do is stand there saying, “boy, I sure hope he has good insurance.”
Is it me or can we all accept the reality that sooner or later we are all going to need medical care. Providing ‘universal’ or ‘socialized’ medicine and cutting out the insurance companies will shift medical care to the same status as fire, police, courts, infrastructure, and education. Medical care should be seen as fundamental and basic a human need as any other. Any medical plan will require a tax increase somewhere; but for what reason do we pay taxes if not for those items we all require.
It matters not a bit to me if a person has medical coverage via a private insurance policy, a public insurance policy, or they simply walk into a government funded clinic, office, or hospital seeking treatment. What matters is that everybody have available to them humane medical attention.
Open the VA hospitals and build dozens more. Change the statute to make services available to “any person” instead of a veteran.
Also, change the language of the Medicare statute by eliminating the words, “age 65 and older” and let Medicare reach out and touch everybody who joins.
Through these two social changes, there will be a basic insurance plan for every person who can afford one and a medical infrastructure available for those unable to pay. Nothing prevents private insurance companies from offering competing products. Nothing prevents a person from paying out of pocket for more than is available through public insurance or public facilities.
I would next take issue with those who argue that costs of medicine have to be gotten under control. Let me posit that even if you reached the absolute maximum benefit for the most minimum dollar, the costs of medicine are still going to climb. Look no further than payroll. We are going to have to give raises to people who work for government facilities and will have to compensate for inflation by paying higher compensation as part of a public insurance plan. Then there is the cost of research and development; something we should vigorously encourage. These two items however, will always keep the cost of medicine and universal coverage creeping upward. We must accept this truism and build a tax structure that takes into account that what costs a dollar today may cost two dollars tomorrow.
The bottom line is that right now there is pending legislation which is more than one thousand pages in length and which no voting member of Congress is going to read. Should any of them actually venture to read the Act, I doubt they will understand what it is that they are voting for or against. We don’t need a massive new federal structure nor a massive new insurance funding program. Already in place are two well functioning agencies that serve well their constituency. Can they be better? Of course we can always do better. The shortcoming of the agencies comes as a direct result of legislators cutting budgets while demanding more performance. That can be fixed easily by public pressure.
We need both; a public insurance and a public hospital system. What I query is why not take advantage and build upon that which we already have instead of starting from scratch.