Toward Universal Healthcare
Justin Katz
In a comment to my recent post about being a doctor in Rhode Island, Old Time Lefty asked (among some insults, statements seeped in common spin, and other junk that I'll ignore):
Health insurance should not be joined to employment. It should be a right. If it’s not a right, do you think it’s a worthwhile endeavor to establish program or programs to cover them all? What program to do this are you espousing?
I'm always hesitant to assent to calling something "a right" in the presence of left-wingers, because the definition of what a given right might entail is generally more expansive and fluid than I believe to be appropriate. However, I'll express general agreement with the proposition that access to healthcare is a right, mainly in order to draw attention to my disagreement with the proposition that health insurance is a right.
Plainly put, "healthcare" and "health insurance" shouldn't be considered synonymous in this discussion. There's a reason you don't use your auto insurance card every time you get an oil change, buy new seat covers, and have your car detailed. Insurance ought to be bought against that which is rare and harmful, not that which is habitual and foreseeable.
So, with this distinction made, how would I provide everybody with access to healthcare?
The first step would be to end price-raising regulations and mandates. That would include all laws that push health insurance into the employee agreement. (Ask Andrew about ERISA.) It would also include requirements that insurance cover viagra, sex-change operation, and a whole medicine cabinet of more common procedures and drugs. Make it possible, in short, for the average citizen to purchase his or her own catastrophic coverage, for use in such illnesses and injuries as ought to bring one to the emergency room or the life-saving surgeon.
The second step would be to make that insurance mandatory. Once we've agreed upon a bare minimum of coverage (taking into consideration severity as well as cost to the public of uncovered treatment). The price really shouldn't be that much, considering the rarity of the use, and perhaps those who still cannot afford it could be covered under a government-negotiated plan with a private provider.
The third step would be to create health savings accounts for every American, created upon birth or naturalization. Each citizen (or his or her parents) would select a firm to administer the account, with the government's role being mainly in establishing the account number and other minor start-up requirements. (The administration would be more akin to bank practices, as opposed to investment practices.) Over a person's lifetime, the individual, employers, charities, and so on could put money into the individual's account (tax free), and he or she could use it solely for medical expenses, including doctor visits, medicine, perhaps even plastic surgery and other electives.
At a certain age, the money could be withdrawn to enhance retirement income, and the full remaining dollar amount could be bequeathed to others, placed in their accounts.
This is just a summary, with some debatable points and specifics to be added for a full-throated policy discussion, and there are a variety of costs and benefits (notably an increase in pay when employers are no longer "responsible" for insurance costs) to such a program that would require more time than a lunch half-hour provides.
Yeah, yeah, yeah... everyone has rights, Lefty. The problem is nobody has responsibilities, thanks to you stupid liberals.
Just like how home ownership became a right. What a joke that one was. It started by lenders being accused of "redlining" because they wouldn't lend to people who couldn't pay for a mortgage. So, after being blackmailed into lending by Marxist liberals punks, to those who should never have gotten a mortgage in the first place, these same liberal jackasses are now saying the lenders engaged in "greenlining" - lending to people they knew couldn't pay the mortgage.
What a joke, thanks to a bunch of stupid liberals.
It rained yesterday - liberals' fault.
It's supposed to get hot this weekend - liberals' fault.
The price of oil went up $4 a barrel today - again, liberals' fault.
God gave us liberals because we need scapegoats.
I was with you until:
>>At a certain age, the money could be withdrawn to enhance retirement income<<
Unless there is some ridiculous amount in there, and I'm talking multi-millions, this part sounds like a bad idea. It's when you're a certain age that you *really* need health care coverage. Allowing a 75 year old (or whatever age) to withdraw from their heath care coverage plan to cover living costs? Then what happens when that person gets really sick? Or is that what the catastrophic insurance was for? It just seems that there is more of a need for coverage later in life and that's not a great time to be pulling out of it for non-medical expenses.
"It rained yesterday - liberals' fault."
No, its nobody's fault and neither is global warming - its not anthropogenic.
"The price of oil went up $4 a barrel today - again, liberals' fault."
Well, you got me there. I absolutely agree. Liberal thinking people oppose:
1)new refineries
2)North Slope Drilling
3)Offshore Gulf drilling, unless done by the Chinese
4)Offshore Florida drilling
5)nuclear
6)offshore wind farms
7)Sasol Fischer-Tropsch process coal gasification
8)offshore port terminals like LOOP that could bring New England the LNG it needs without the danger of sailing it up the Bay
and so forth and so on
Hawaii is exempted from ERISA.
Hawaii is the only state in nation to be closest to providing universal healthcare to its total state population (still tweaking the system).
One major offshoot of being that close to 100% universal healthcare is Hawaii leads the nation in having the highest longevity of its population.
Justin,
What you describe is quite similar to the Australian healthcare system (which delivers much better healthcare outcomes than ours, at a much lower percentage of total GDP spent on health care). In broad terms, every Australian is covered by national health insurance. However, many procedures are not covered, and must be paid for either out of a patient's pocket or via "top up" health insurance sold by private companies. Which services and procedures are on either side of this line is a subject for political debate, which is legitimate. Services are largely delivered by competing private sector suppliers. Over consumption is controlled via a deductible (i.e., a price signal).
Bottom line: the outlines of a viable approach to national health insurance are clear. The greater problem, however, lies in the challenge posed by the large number of illegal immigrants in the U.S. If that problem isn't addressed, you can pretty much forget about national health, as the costs would be prohibitive. This is why Tony Blair (yes, the sainted Tone so beloved by many Democrats)insisted on strict testing to prevent use of National Health in the UK by illegal immigrants. That is also one of the reasons Canada rigorously enforces its immigration laws -- they realize that if they didn't, their national healthcare system would quickly be overwhelmed by rapidly rising costs.
Of course, I won't hold my breath waiting for Old Time Lefty to make the connection between these two issues (much less draw the same conclusion as Tony Blair).
The problem in this country is that the usual "progressive" suspects would decry the "inequality" of the "rich" being able to afford "comprehensive" health care while others must make due with only "catastrophic" coverage.
Before long the mission creep would begin, adding this and that to the mandatory coverage.
Eventually we'd reach their dream state, true "equality":
"Comprehensive" "single payer" health care;
Paid for by incredibly punitive taxes on everyone (including the middle class - for there'd never be enough "rich" to fund government - right now the middle class are getting killed by taxes because we don't have enough rich to fund our expansive government);
With ever-declining quality, rationing through waiting periods and other restrictions on access;
Ever increasing doctor shortages, and older ones retire and young people won't incur the expense and time of medical school, only to face ever-declining incomes as government keeps lowering reimbursements (i.e., all of health care will be like Medicare today);
The end of medical progress, as the free market will be eliminated from health care, there will be little incentive for pharmaceutical companies or biotech companies to invest in research, only to have the government bureaucrats (as the "single payer")what is a "fair price" they can receive for their investment.
The "progressives'" desire for "single payer" / "universal" health care isn't about health care at all (much less quality health care) - it is about growing their church, i.e., government.
Justin,
You may be coming around. Keep working on it. We have to get these people covered. You agree that "healthcare is a right, mainly in order to draw attention to my disagreement with the proposition that health insurance is a right." Bravo, whether coverage comes from insurance, from on high by the Almighty, or via government programs is totally inconsequential to the problem. Let's get these people covered in one way or another. So, as I read your statement we go hand in hand in wanting to provide coverage for all.
A couple of fuzzy areas need to be cleared up. Help me along with this one: You also write, "Make it possible, in short, for the average citizen to purchase his or her own catastrophic coverage, for use in such illnesses and injuries as ought to bring one to the emergency room or the life-saving surgeon." What do you suggest for people with chronic illnesses like diabetes, multiple sclerosis and the like? Do people suffering from such illnesses collide with your dictum that "Insurance ought to be bought against that which is rare and harmful, not that which is habitual and foreseeable." How do you square that statement with people who suffer with chronic illnesses?
All told, keep at it and remember that we - you and I, your friends and mine - share a common goal which is coverage for everyone.
"create health savings accounts for every American... This is very suspect. It's a splendid idea if you can schlep up the money to put into an account, the more the merrier; and it would be a bonanza benefit for the very wealthy. No thanks on this one. The rich should not benefit over the poor in any program in which the government is involved. you are handing the wealthy and the very wealthy a fabulous tax dodge whereby thay can stash away tax free cash and, if they choose withdraw it to use for non-medical expenses. A terrific idea for millionaires and a(s)crap to the poor. It's very much like saying that the law is equal, neither the rich nor the poor may sleep on a park bench, but only the poor have to.
OldTimeLefty
"Insurance ought to be bought against that which is rare and harmful, not that which is habitual and foreseeable." How do you square that statement with people who suffer with chronic illnesses?
You do that by recognizing that some reasonable and customary costs should be paid directly by the consumer, in order to reduce paperwork overhead - and costs - for incidentals. Chronic illnesses are not what I would term habitual and foreseeable. In the 1950's a health plan deductible was $100 per individual. Today, it should be some multiple of that. Using that larger deductible you can reduce overhead more by not worrying about what is chronic vs reasonable, habitual and foreseeable. You can then toy around with having an itemized medical deduction even for people - typically lower income - who take the standard deductions. Put a floor in as a percentage of income as done now.
How about a free market in health care? What we have in RI is an almost monopoly, with the Blues suffering United Healthcare in order not to be so blatantly a monopoly. Its just as bad and politicized as if the government were running it directly plus you still pay upper management handsomely. Any of us should be able to buy healthcare from any source registered in any state. I used to be able to do that in the 70's and 80's from Mutual of Omaha and Unum. Let's open the market up with less government obstruction. BTW, this doesn't say anything about who pays the premiums. All it says is let the market bid for the money provided.
Health care insurance is NOT a right.
Small, honest, accountable, responsive, and responsible government IS a right.
The Regressives have their priorities mixed up.
Citizen Critic,
Small, honest, accountable, responsive, and responsible government IS a right
No, my friend Small, honest, accountable, responsive, and responsible government IS our DUTY. We are the government and until people take the responsiblity instead of demanding rights we will continue our downward spiral
"It rained yesterday - liberals' fault.
It's supposed to get hot this weekend - liberals' fault.
The price of oil went up $4 a barrel today - again, liberals' fault.
God gave us liberals because we need scapegoats."
Are you guys want to stop blaming everything on Bush?
Didn't think so.
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Yeah, yeah, yeah... everyone has rights, Lefty. The problem is nobody has responsibilities, thanks to you stupid liberals.
Posted by: Mike Cappelli at June 5, 2008 1:59 PMJust like how home ownership became a right. What a joke that one was. It started by lenders being accused of "redlining" because they wouldn't lend to people who couldn't pay for a mortgage. So, after being blackmailed into lending by Marxist liberals punks, to those who should never have gotten a mortgage in the first place, these same liberal jackasses are now saying the lenders engaged in "greenlining" - lending to people they knew couldn't pay the mortgage.
What a joke, thanks to a bunch of stupid liberals.
It rained yesterday - liberals' fault.
Posted by: rhody at June 5, 2008 2:37 PMIt's supposed to get hot this weekend - liberals' fault.
The price of oil went up $4 a barrel today - again, liberals' fault.
God gave us liberals because we need scapegoats.
I was with you until:
>>At a certain age, the money could be withdrawn to enhance retirement income<<
Unless there is some ridiculous amount in there, and I'm talking multi-millions, this part sounds like a bad idea. It's when you're a certain age that you *really* need health care coverage. Allowing a 75 year old (or whatever age) to withdraw from their heath care coverage plan to cover living costs? Then what happens when that person gets really sick? Or is that what the catastrophic insurance was for? It just seems that there is more of a need for coverage later in life and that's not a great time to be pulling out of it for non-medical expenses.
Posted by: PJ at June 5, 2008 3:13 PM"It rained yesterday - liberals' fault."
No, its nobody's fault and neither is global warming - its not anthropogenic.
"The price of oil went up $4 a barrel today - again, liberals' fault."
Well, you got me there. I absolutely agree. Liberal thinking people oppose:
1)new refineries
Posted by: chuckR at June 5, 2008 3:43 PM2)North Slope Drilling
3)Offshore Gulf drilling, unless done by the Chinese
4)Offshore Florida drilling
5)nuclear
6)offshore wind farms
7)Sasol Fischer-Tropsch process coal gasification
8)offshore port terminals like LOOP that could bring New England the LNG it needs without the danger of sailing it up the Bay
and so forth and so on
Hawaii is exempted from ERISA.
Hawaii is the only state in nation to be closest to providing universal healthcare to its total state population (still tweaking the system).
One major offshoot of being that close to 100% universal healthcare is Hawaii leads the nation in having the highest longevity of its population.
Posted by: Ken at June 5, 2008 6:20 PMJustin,
What you describe is quite similar to the Australian healthcare system (which delivers much better healthcare outcomes than ours, at a much lower percentage of total GDP spent on health care). In broad terms, every Australian is covered by national health insurance. However, many procedures are not covered, and must be paid for either out of a patient's pocket or via "top up" health insurance sold by private companies. Which services and procedures are on either side of this line is a subject for political debate, which is legitimate. Services are largely delivered by competing private sector suppliers. Over consumption is controlled via a deductible (i.e., a price signal).
Bottom line: the outlines of a viable approach to national health insurance are clear. The greater problem, however, lies in the challenge posed by the large number of illegal immigrants in the U.S. If that problem isn't addressed, you can pretty much forget about national health, as the costs would be prohibitive. This is why Tony Blair (yes, the sainted Tone so beloved by many Democrats)insisted on strict testing to prevent use of National Health in the UK by illegal immigrants. That is also one of the reasons Canada rigorously enforces its immigration laws -- they realize that if they didn't, their national healthcare system would quickly be overwhelmed by rapidly rising costs.
Of course, I won't hold my breath waiting for Old Time Lefty to make the connection between these two issues (much less draw the same conclusion as Tony Blair).
Posted by: John at June 5, 2008 7:20 PMThe problem in this country is that the usual "progressive" suspects would decry the "inequality" of the "rich" being able to afford "comprehensive" health care while others must make due with only "catastrophic" coverage.
Before long the mission creep would begin, adding this and that to the mandatory coverage.
Eventually we'd reach their dream state, true "equality":
"Comprehensive" "single payer" health care;
Paid for by incredibly punitive taxes on everyone (including the middle class - for there'd never be enough "rich" to fund government - right now the middle class are getting killed by taxes because we don't have enough rich to fund our expansive government);
With ever-declining quality, rationing through waiting periods and other restrictions on access;
Ever increasing doctor shortages, and older ones retire and young people won't incur the expense and time of medical school, only to face ever-declining incomes as government keeps lowering reimbursements (i.e., all of health care will be like Medicare today);
The end of medical progress, as the free market will be eliminated from health care, there will be little incentive for pharmaceutical companies or biotech companies to invest in research, only to have the government bureaucrats (as the "single payer")what is a "fair price" they can receive for their investment.
The "progressives'" desire for "single payer" / "universal" health care isn't about health care at all (much less quality health care) - it is about growing their church, i.e., government.
Posted by: Tom W at June 5, 2008 9:35 PMJustin,
You may be coming around. Keep working on it. We have to get these people covered. You agree that "healthcare is a right, mainly in order to draw attention to my disagreement with the proposition that health insurance is a right." Bravo, whether coverage comes from insurance, from on high by the Almighty, or via government programs is totally inconsequential to the problem. Let's get these people covered in one way or another. So, as I read your statement we go hand in hand in wanting to provide coverage for all.
A couple of fuzzy areas need to be cleared up. Help me along with this one: You also write, "Make it possible, in short, for the average citizen to purchase his or her own catastrophic coverage, for use in such illnesses and injuries as ought to bring one to the emergency room or the life-saving surgeon." What do you suggest for people with chronic illnesses like diabetes, multiple sclerosis and the like? Do people suffering from such illnesses collide with your dictum that "Insurance ought to be bought against that which is rare and harmful, not that which is habitual and foreseeable." How do you square that statement with people who suffer with chronic illnesses?
All told, keep at it and remember that we - you and I, your friends and mine - share a common goal which is coverage for everyone.
"create health savings accounts for every American... This is very suspect. It's a splendid idea if you can schlep up the money to put into an account, the more the merrier; and it would be a bonanza benefit for the very wealthy. No thanks on this one. The rich should not benefit over the poor in any program in which the government is involved. you are handing the wealthy and the very wealthy a fabulous tax dodge whereby thay can stash away tax free cash and, if they choose withdraw it to use for non-medical expenses. A terrific idea for millionaires and a(s)crap to the poor. It's very much like saying that the law is equal, neither the rich nor the poor may sleep on a park bench, but only the poor have to.
Posted by: OldTimeLefty at June 6, 2008 1:40 AMOldTimeLefty
"Insurance ought to be bought against that which is rare and harmful, not that which is habitual and foreseeable." How do you square that statement with people who suffer with chronic illnesses?
You do that by recognizing that some reasonable and customary costs should be paid directly by the consumer, in order to reduce paperwork overhead - and costs - for incidentals. Chronic illnesses are not what I would term habitual and foreseeable. In the 1950's a health plan deductible was $100 per individual. Today, it should be some multiple of that. Using that larger deductible you can reduce overhead more by not worrying about what is chronic vs reasonable, habitual and foreseeable. You can then toy around with having an itemized medical deduction even for people - typically lower income - who take the standard deductions. Put a floor in as a percentage of income as done now.
How about a free market in health care? What we have in RI is an almost monopoly, with the Blues suffering United Healthcare in order not to be so blatantly a monopoly. Its just as bad and politicized as if the government were running it directly plus you still pay upper management handsomely. Any of us should be able to buy healthcare from any source registered in any state. I used to be able to do that in the 70's and 80's from Mutual of Omaha and Unum. Let's open the market up with less government obstruction. BTW, this doesn't say anything about who pays the premiums. All it says is let the market bid for the money provided.
Posted by: chuckR at June 6, 2008 4:24 PMHealth care insurance is NOT a right.
Small, honest, accountable, responsive, and responsible government IS a right.
The Regressives have their priorities mixed up.
Posted by: Citizen Critic at June 7, 2008 12:27 AMCitizen Critic,
Posted by: Bob C at June 8, 2008 8:27 AMSmall, honest, accountable, responsive, and responsible government IS a right
No, my friend Small, honest, accountable, responsive, and responsible government IS our DUTY. We are the government and until people take the responsiblity instead of demanding rights we will continue our downward spiral
"It rained yesterday - liberals' fault.
It's supposed to get hot this weekend - liberals' fault.
The price of oil went up $4 a barrel today - again, liberals' fault.
God gave us liberals because we need scapegoats."
Are you guys want to stop blaming everything on Bush?
Didn't think so.
Posted by: EMT at June 8, 2008 2:17 PM