Health Care

Talking about healthcare is like putting one's hand on a hot griddle.

Here are some facts to inform the debate:
We are the richest country in history and in the world.
ALL other rich, industrialized countries provide universal health care to their citizens.
In the Soviet Union, if you didn't work you didn't eat, but they never denied healthcare.

Why do we?

Here are some more facts to inform the debate:
The healthcare industry is a six trillion dollar per year business.
That much value is not delivered.
There are lots of $7 aspirins billed and paid for.
Do the sellers of those $7 aspirins pay taxes on that obscene profit for a one penny pill?
"Oh it's complex. You don't understand. There are development costs. Plus the cost of shipping all that money to Switzerland."
If taxes were paid, commensurate with markup, maybe universal healthcare would be affordable.

Some people suggest universal healthcare as in other countries.
Is that desirable? Yes and no.
Some people in favor of universal healthcare view it as a scenario where you walk in, take a number and they give you new set of lungs.
Some people opposed to universal healthcare view it as a scenario where you walk in, take a number and they give you new set of lungs.
Does this mean they're in agreement?

Human beings and human reactions to stimuli are complex variables.
Some things are reasonably predictable.
Humans respond to positive stimuli (incentives) and humans respond to negative stimuli (disincentives).
"Carrots' and "sticks" if you will.
If there were only incentives, we'd eat sugar until our pancreas fails (we do anyway).
If there were only disincentives, it would be a gray world and possibly might infringe on what we cherish as "freedoms".
Mayhaps a healthy mix of "carrots' and "sticks".

Imagine the following:
"Mr. Smith, I see you're still smoking cigarettes, but we're going to give you your third set of lungs anyway."
"Mrs. Smith, I see you weigh 900 lbs., but we'll continue to supply new wheelchairs and some chocolates to cheer you up when they break."

How about:
"Mr Smith, once is your fault, twice is our fault. You'll get your third set of lungs when you quit smoking."
"Mrs. Smith we are prescribing a strict diet and a physical therapy routine which you must follow,
otherwise we are only obligated to supply oxygen as needed."

Extreme examples? Perhaps, but the first example is the world view anti-universal coverage people have of the outcome.
Unfortunately, that is a common real world outcome (allegorically) and the healthcare industry charges gobs of money and guess who pays?
The second example is an approach that tempers sterness with common-sense. Some might say "meanness".
Not as "mean" though as denying healthcare.
In an ideal world, there would be intervention before the three-pack-a-day habit or ten lbs. of chocolate bon-bons.
This has a nasty name not dared spoken in the halls of big business.
It's called "preventative medicine".
Evil things like physicals, mammograms, vaccinations, exercise, etcetera.
Preventative medicine is the most cost-effective part of total medicine.
Minor problem.
There is not nearly the profit giving advice to increase the green, leafy vegetables in your diet as there is in an $18,000 MRI.

There exists in the healthcare industry a continuum from donated care to fair pricing to exorbitant pricing to outright fraud.
Collapsing this spectrum would rein in some excess costs.
This author's mother broke her hip and later needed a walker.
This author went to a scrap yard he knew and bought one for $3 after pricing one for $10 at a thrift shop.
Later that week, a car pulled up and a contactor delivered a walker paid for by Social Security for $189.
The following week, the author saw the identical walker in the pharmacy for $39.
That's a range of 6900%.
Now add a few zeros on those numbers and it begins to look like corporate healthcare.
It is no wonder some people don't want their tax dollars going there.
Likely, these same people would find it reasonable and charitable to spend a sixth of that for the $39 walker.
People are not evil (generally) & those (generally) against universal healthcare are reacting to $189 walkers and the fraud inherent in them.
If there were a sensible system, likely many idealogical concerns would be deflected.
People are not evil.
Another concern- people do not "steal" healthcare.
"Oooohhhh that colonoscopy was so much fun! I'm going to go get six more next week under a fraudulent name!"

Which brings us to the Affordable Care Act (ACA) or "Obamacare".
There are claims it is defective, it is hideously & needlessly complex & is riddled with opportunities for exploiters- both individuals & corporate.
That is correct.
But it is better than nothing.
20,000,000 have healthcare who didn't before.
Numerous cancer patients (and a goodly number of cancer survivors-yippee!) have care regardless.
Seventy-four percent want it retained albeit with some modifications.
But it cuts into profits. Grrrrr.
If it has deficiencies, modify it. Make it simpler.
Simpler. A key word. Simplify. A verb. Do it!

So we've established ACA is evil, impotent, and distorts "free enterprise".
(Note: the original framework for ACA was written by the right-wing Heritage Foundation
for Mitt Romney's Massachusetts healthcare and subsequently adopted as the model for ACA.)
Should we replace it with something worse, more complex and more expensive? Not unless you've gone long on healthcare stocks.

Hidden away within the labyrinth bureaucracy of the Federal Government is a small, seemingly unknown program called "Medicare".
It is part of another sly program called "Social Security".
These have been lurking around for seventy years and appear to have accumulated a whopping 2.7 trillion dollar nest-egg.
They are solvent and they are solvent for the next fifty years out with minor tweaks.
Perhaps an incrementalist approach is in order here.
Shift some of the burden off ACA causing it to slowly disappear and add some to Medicare.
How could that be accomplished incrementally without disruption and huge cost increases?
How about for each year that passes, extend Medicare eligility a year earlier.
That would mean that while 65 year olds now receive it, in ten years, 55 year olds would be eligible.
Of course, the 55 year olds would have to keep paying into it until they are 65, but that would have the unusual result of funding it.
(This is not to suggest giving Social Security to 55 year olds- just Medicare- and they pay for it.)
After twenty years, 45 year olds would be covered (and pay for their coverage twenty more years til sixty five).
If it is found to work, it could be extended more quickly.
Another plus- the bureaucracy and framework already exist for Social Security and Medicare.
Add two more secretaries and more computer memory and you could double the number of enrollees for a pittance.
(Not exactly, but you get the point.)
The incremental approach also affords the possibility to tweak the program and improve it as needed.
All the while, the statistical input of the Congressional Budget Office can monitor that it remains "revenue neutral".
By the way, Social Security and Medicare are not "entitlements". They were paid for. It is a contract with the "buyer".
Would anyone agree to do this?
Nahhh. Makes too much sense.

In that vein, "How to pay for it?"
A study has been released (attributes and links to follow) showing that if everyone paid $59 per month per $20,000 annual income,
universal healthcare would be possible.
That is a rate of 3.5%.
Not 40%. Not 100+%.
Sounds like a proposal very much like this author's under taxes.

What about the private sector in medicine and insurance?
In a free society, they have a right to be there as well.
We have no more right to exclude them than they have the right to exclude us.
So let a private insurance program flourish alongside.
The market will decide which works better.
People can choose according to their philosophy or their wallets.
The market will compel private insurance to dream up a better plan in order to compete.
Challenge is on.

Postscript: How about if we legislate Senators and Congresspersons get the same healthcare system we do?

Post Postscript: What percentage of your car insurance is medical coverage? Thirty percent? Fifty percent?
If there were universal health coverage, car insurance would be at least thirty percent cheaper.
What about Workman's Comp? Talk about a burden for small business.
The Architectural Director at City Museum is now in a 40% bracket for some kinds of architectural salvage!
If there were universal coverage, there would be no need for workman's comp.
Employerss could hire numerous more workers.
None of those workers would need health plans either.
Why aren't they on board with this?

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