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posted on: 3/5/2012
revised:
Over the past twenty five years I've
probably published several hundred consumer warnings about the
looming U.S. health care crisis. These ranting have been scattered
in far too many print and social media outlets to allow anyone to
keep track. I really have not made any effort to track or quantify
my chronic obsessive fear. As a lifelong advocate
of national health care reform, I felt a huge let-down in 2010 when our national
efforts were diverted from health care reform to health insurance reform.
Now I'm near panic as the impact of the ridiculously mis-named "Affordable Care
Act" begins to take effect to make a bad situation even worse by
jolting our health care costs higher. The problem has become acute
and the worst is yet to come.
My worse fears at this point are that: a) political
bantering obscures the facts so that a large portion of Americans
fail to see the basic truths in the big picture, and 2) that our
political climate and power structure make real change almost
impossible without a large scale economic collapse.
If there is any bright spot in this story, it is that
a growing number of mainstream media outlets have been willing to
fairly present the findings of researchers and national experts on
this topic. The updated points in this editorial are inspired
largely from coverage in tomorrow's New York Times of an interview
with Stanford economist Victor Fuchs. (I read a
preview version online).
Here are the points we need to keep in focus:
We don't have a debt crisis, we have a health
care spending crisis.
We spend over twice the amount on health
care per person as other countries. Half of all the health
care paid by the government. This expense is crowding out all of the
other functions of state and local government like education, roads,
infrastructure and social services. The federal government finances this huge
expense by selling debt, mostly to China.
Current federal budget projections
indicate that within a decade 100% of our nation's total tax revenue
will be spent on providing health care, social security and paying
interest on our past debts. The government's fastest growing expense
is health care.
If we brought our health care spending in line with other modern
nations, our other fiscal problems would fade away. Yet without
radical health spending reform, all of the efforts we may make
toward fiscal responsibility in government will be futile.
Why we need to focus on the solution, not the problem
There are many reasons that we pay
too much for health care. I could double the length of this
editorial simply by listing all of the reasons here; yet that would
not help solve the problem. Finger-pointing is a complete
waste of time. We recognize that identifying the individual problems
in the health care system and then trying to chip away at them piece
by piece from a legislative angle is not likely to be an effective
strategy.
It is important to realize that the Supreme Court's decision on the
Affordable Care Act this spring will have no significant impact on
the health care crisis. Likewise for political actions to repeal the
2010 reform law. Waiting out these outcomes on the future of PPACA is also just a waste of
time.
A single-payer system won't work here
Some suggest throwing out the entire health care system in favor of
a single-payer governmental system. Yet Americans are clear in that
we really do not want that; there is little public support for
abandoning our health care system in favor of a European-style
single payer system.
The reform strategy that will actually work
If we strip away all the political spin,
we can see that is a consensus of opinion among our nation's
sharpest economic minds that two step legislative approach
would allow the market to solve the problem in a natural manner. The
two required changes are: 1) a tax to provide basic universal coverage,
and 2) elimination of tax deductions for health care.
A national value-added tax would be used
to provide a basic universal health plan much like Medicare but with
more of a consumer-driven approach. Individuals and businesses would
be free to purchase supplemental insurance for coverage above the
minimum care, but only on an after-tax basis.
The elimination of the tax deduction for health
benefits would make our health care independent of our employment;
employers will be glad to get out of the health care business.
Individuals spending their own take-home pay on health care and
health insurance will show far more diligent consumer behavior.
Some will oppose
reform
Health care reform will cut the pay of doctors,
health care and insurance executives so we should reasonably expect
some opposition. Unions would probably oppose the change. We should
recognize that a small portion of us are ethically opposed to any
system that allows rich people to get better health care than poor
people; these people tend to support a pure single payer system.
Yet I believe that I sense a growing level of support
for this reform proposal among all interest groups from doctors in
individual practice, health care providers, insurance companies and
business executives; 1 percenters and 99 percenters alike. We all
realize the current system is unsustainable and the logic of the
reform proposal seems valid.
We need to remember that a successful reform strategy
must preserve our freedoms to purchase or not purchase health
insurance and to choose the medical providers we wish to use.
When will we see this get moving?
Unfortunately, I predict that it will take an
economic depression to build the political momentum to implement
this reform. This may be at least several years away. Until then,
regrettably, all financial aspects of our governments and our health
care systems will continue to deteriorate. Yet I know that one way
or another, I will see radical health care reform within my
lifetime.
keywords: universal health
care, health insurance,
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