Stop the Presses | If health-care reform were up to me …
One caveat: It has to fit in today’s political reality. Otherwise, this is a one-word (hyphenated) column: single-payer.
Even then, though, what I’ve been mulling over the past several weeks would fit into the single-payer model that I envision being politically palatable maybe around 2035.
But we’re still in 2009.
So back to where we were.
If health-care reform were up to me …
First, to the premise: We pay more per capita, a lot more, 10 percent more than the next country, on health care, and aren’t getting the results, unless you count being #50 in the world in life expectancy, six months up on Cuba, which spends 1/25th of what we do per capita on health care, as getting results.
So we’re spending more money for less results. My ideas on efficiency tell me this isn’t efficient. And that we need to reallocate resources.
How to do that: the education model.
Before you get ahead of me – my education model is based on what my Republican friend Chris Saxman has been able to sell me on. And that is – a mix of public and private, with tax credits available to parents to use in a school-choice model that would allow parents to sign their child up for a public school outside their geographic district or a private school. The tax credits would come in around 25 percent of what the state allocates per pupil for public education. And people who would qualify for the tax credits would be subject to income caps, so that we could ensure that the money is going to working- and middle-class families and not the superwealthy.
I’ve been catching heat from Democrats for backing this idea, but it was with a purpose in mind.
Consider: a public option that guarantees health-care coverage for all, like we guarantee public education for all.
You can still opt out and go totally private. You can go quasi-private, keeping your public coverage and buying supplemental coverage to go with it. Sort of like how you can send your kid to public school and hire a tutor, or send them to an art class on Saturday morning, or space camp in the summer.
If you meet the income qualifications, you qualify for a tax credit that you could use either to go private or buy the supplemental.
Warning: This would, I expect, mean higher taxes. But it would also mean for almost everybody lower out-of-pocket costs. Think about the difference between sending your kid to public school and private school. Virginia spends around $11,000 per pupil on public education. A good private-school education is going to cost you $15,000 easy.
You can argue that the quality of the education at the private school is going to be better. I can argue that 90 percent of us went to public school, and it served most of us more than adequately.
In the end, whether we’re taxpayers or consumers, we’re paying.
What we need to work toward is a lower macro cost. A lower macro cost means lower per-capita cost.
Whether or not the per-capita cost is 20 percent taxes and 80 percent insurance premiums or 80 percent taxes and 20 percent insurance premiums is irrelevant to me.
What matters to me is the how much.
As to the results: I propose one additional tax credit – for the healthy.
In the first year, we’d offer everybody a tax credit equal to the cost of a routine physical with their family doctor. This physical would be used to provide a baseline for your health status. In year two and beyond, if you either maintain a level of good health or improve upon your health by losing weight or quitting smoking or some other factors, you’d qualify for a $1,000 tax credit.
The idea is to incentivize good health, which in the long run improves quality of life and reduces health-care costs on the aggregate.
This program would prove to be quite popular, I imagine as popular as the recent Cash for Clunkers program. All you have to do is lose a few pounds every year, really, to qualify. Those few pounds at the macro level add up to less in terms of obesity and its associated problems of diabetes and asthma and heart disease and joint and back problems. So we the people benefit because we should over time see less pressure on the health-care system from having to treat these ailments.
Before you take the time to castigate me for being short on specifics: I’m aware I’m short on specifics.
I’m thinking framework here.
I use public education as the model on costs because public schools educate roughly 90 percent of all students at a rate lower than what the other 10 percent who go the private-school route pay.
The 90-10 split in education interests me. I wonder if over time we wouldn’t see a similar split on public vs. private health insurance.
The good-health tax credit, I think, is the sleeper here.
We might buy ourselves into cheaper health care in the long run using that.
Anyway, that’s if it were up to me.
It’s not, of course.
- Column by Chris Graham
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Chris, may I recommend Matt Taibbi’s Is Health Care Reform Doomed? in the September 3 issue of Rolling Stone. The problem with lack of reform isn’t a lack of ideas; it’s a lack of political will. What you call “political reality,” Matt calls . . . well, something else. He doesn’t mince words.
In all my years of advocating for single-payer I’ve encountered advocacy for the privileging of the healthy citizen from all sorts of political stripes. Every healthy citizen is one minute away from slipping into the unhealthy category —- an accident on Interstate 81, an antibiotic-resistant infection picked up during some routine procedure at a local hospital, environmental factors over which we have little to no control that produce an aggressive cancer, or a swine flu that hits the young and seemingly healthy with more force than those of us inching our way to Medicare. At the same time, those of us born into poverty need a lot of luck to ever get to that privileged healthy column, not to mention those whose genetic make-up pushes them into that column from birth. When we privilege the healthy, we demonize those who aren’t, whether through their own bad habits or circumstances beyond their control. I hope with all my heart we don’t go there.
I fully agree with Sherry Stanley. Single-payer is the way to go. Health care should not be a business. Health care should be a right of all citizens.
It’s a going to be an uphill battle to pass health reform with the passing of Sen. Ted Kennedy who was the Congressional advocate for reform for the past thirty or more years.
If you want to educate the public about health care, write about the donations by health care corporations to politicians and political parties. It’s no surprise to discover these corporations rank in the top ten percent. Health care lobby groups far surpass other corporate or political action committee lobbyist in the United States.
Why? It’s nothing more than greed. It has nothing to do with caring for people.
So we’ve got two votes for single-payer. And no votes for my idea that the political reality of 2009 wouldn’t endorse single-payer.
And no comments on the framework I’ve proposed.
Let me speak my mind on my own government control aspects. I do not want government controlling any aspect of my health control. I am one of those “veterans” who have been subjected to the end of life scenario. I am also one of those Americans who are ill and am close to death at the age of 53. When I had my stroke, it took 6 months to be out of work and starving emotionally and physcially to be “eligible” for Social Security benefits. This was not earned as a “freebe”. I had invested 39 years into Social Security as it stood, but it required me to be “proved” disabled after 6 months. Medicare? We payed into that also. I attempted the good ol’ VA as I am a Vietnam Veteran. They advised me they take the previous years earnings and not the new “O” income that I had now. I was going down with the ship. If not for the help of freinds, not government programs, I would have been writitng from the tunnels under Staunton.
It took 3 years of Medical appeals to the VA to be approved. Single Payer?
Good Grief Charlie Brown. My idea aligns quite a bit with Chris with one exception. Sorry Chris. Show American First we can fix the government programs in existence for Health. Fix Medicare, Fix Social Security and many other Government aided heal programs. Let us see the government can do that first. Then look at the success of those and re-think single payer system.
I am glad people come on here and express opinions without being :harsh” on one another Chris. Kudos’ to you and the readers.
I used the word “reality” in my column above, and I’ll do it here again to make another point.
Reality is, the private sector has not shown it can manage health care. I go back to my premise. We pay more, a lot more, per capita for health care than any other country, and get much less in terms of outcomes.
Critics of single-payer point out issues with Medicare and the VA. The private sector has its own issues, obviously. Whatever one’s political ideology might be, we can’t accept paying a lot more than everybody else does and getting much less in return. That’s the health-care system as is, and it’s obvious that it needs to be reformed.
I propose a hybrid public-private system as the best means for achieving the efficiencies. I also think long term that the public sector will prove to be more efficient in managing the health-care system than the private sector has. Going the route I suggest allows for a smoother transition than doing it cold turkey.
You were born 30 years too late. People having gotten too set in their ways, locked into what they have now.
Now in 2035, the youngest of the Baby Boom Generation will be 71. The Baby Boom is a big group to deal with, and whatever you do will make many people mad.
They’d be madder if our health-care system has been allowed to continue to be as ruthlessly inefficient in terms of costs and service delivery for 30 years with nobody doing anything to inject some sense into how it’s run.
I read Karl Rove’s piece this morning on the Wall Street Journal. (I know, your eyes, they burn reading his name). He talks about Medicare Advantage, passed in 2003 and may be cut under the Obama plan.
It’s like building a house, adding an addition and then tearing down the addition for something else. And each party wants to build its own addition with each change of power at the White House.
So if you build an addition to your house, and realize six years later that a new floor plan would work much better, be much more efficient, you would look at doing that. The house isn’t all that efficient right now, and it’s to a point where we can’t afford not to look at making some changes.
But Medicare Advantage is where Grandma and Grandpa watch their TV. And they like it.
Grandma and Grandpa aren’t living here anymore. They’re in a retirement community, spending the inheritance on rent, meals and meds. Their middle-aged kids are the ones with the house. Which they might lose if Dad gets downsized or Mom’s company has to drop her because she’s 50 and getting too expensive to insure.
The addition built by Democrats now will be remodeled by Republicans in the future and remodeled further by Democrats.
Besides, government is just efficient in trying to win votes.
Those of us who go to or graduated from public schools and use public roads and rely on publicly-provided public-safety services and a publicly-administered national defense might beg to differ on that point.
Me, I don’t mind the remodeling. What matters to me is getting it right.
Then you’re waiting for Sarah Palin – she’ll get it right.
Yes, can’t wait for her to be president, then decide two years into it that she’s had enough and decides to move on to her own reality show or a ghostwritten book that she’d have to have somebody read to her.
When she resigns, I’ll be president. And you’ll be press secretary. And Helen Thomas will still be on the front row.
Thinking about your house analogy, the basement leaks. So change means pumping water out or pumping water in. Both are change.
We’ve got a nice new sundeck, built by local builders. And the plan wants to chop it up for firewood.
People say they want change. But change can either make things better or much worse. Which is why support for health care reform falls as more information comes out about it.
I don’t want to be press secretary. Make me Minister of Propaganda, and I’m in.
Since this thread was initiated under a column headlined “If health-care reform were up to me …”, let’s at least pretend that we read it and discuss what was proposed.
My plan doesn’t chop up health care for firewood. Hospitals aren’t going to be burned down. Doctors aren’t going to be sent to the gulag. My plan simply creates a public option that will work as public schools work in our education system. You can still go the private-insurance route if you want, or you can go the public-option route. Same as you can send your kids to private school if you want, or you can send them to the public school.
I’m building another room on the house. That’s remodeling. That’s reform.
“People say they want change. But change can either make things better or much worse.”
I think we’re all lucky modern-day Republicans weren’t sitting around the table in 1776 when we were deciding what to do about our Britain problem. “This American Revolution we’re talking about can either make things better or much worse. So we’re for not doing anything.”
What were you guys called back then – Tories! Yes. Tories. A useful lot they were. Pretty much like the Whigs.
Tangents are fun!
There’s a name for Tories now – Canadians. So they got national health care first, in the long run.
Republican ideas for health care reform have always tended toward the regulation side – tort reform and limiting government red-tape – and giving more choice through health savings accounts. Maybe more radical than single-payer, since you are putting a lot of trust in the people’s hands.
But lawyers in Congress don’t want to curtail their power or limit their income, so they go after doctor’s income and those associated with the medical profession.
To paraphrase Donald Rumsfeld, you go to battle with the world you have, not the world you wish you had. The plan being debated now disrupts enough lives that you’re seeing the impacts at town hall meetings.
What we’re seeing at the town halls is demonstrations organized by the health-care lobby and their willing co-conspirators in the GOP and the right-wing media and counterdemonstrations organized by the health-reform lobby and their cohorts in Democratic Party circles.
There isn’t a thing authentic to it. Both sides are flexing their political muscles. Judging from the poll numbers, we are where we were last November on this. A lot of wasted effort, if you ask me.
Bottom line – the system we have isn’t efficient, cost-wise or results-wise. It’s insanity, to borrow from Einstein, to keep doing the same thing over and over and expecting a different outcome. But the insanity is being done not because the people perpetrating it think there will be any different outcome. The insanity that is our health-insurance system is practiced over and over on us because it makes a few people at the top of the food chain a lot of money.
We can keep playing these stupid games, or we can act like adults and figure out a way around a problem for once.
And while all this is going on, when will any politician step up to the plate on one of the really huge reasons why medicine is so expensive;
and tackle torte reform
Tort reform. Sounds like a good plan.
Tort reform is not a “plan.” I think it can be a part of the plan. It’s not nearly everything. But a part of the solution? Yes.