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