Sunday, February 10, 2008

A Universal Health Care Plan That Might Pass

Physicians for a National Health Program are a grassroots organization of medical doctors, healthcare professionals, and medical students proposing a single-payer system of the sort proposed by Dennis Kucinich. The site is obsessively and extensively documented. The only problem I see is that it makes too much sense. What is more likely is a compromise.

I posted this yesterday at The American Street, but this issue is so important to me that I'm reposting it in its entirely here. We all know that the best solution is not always the won that passes muster and I'm attempting to find a system that would pass Congress and be signed into law by the President.

Let me begin this post on a personal note. I am twenty-seven years old, male, white, college-educated, and have both a B.A. and graduate school credit to my name. I work two jobs and both combined provide a whopping $19,000 a year. Thanks to the student loan Gods, I owe $24,000 in loans to the government, approximately $2,000 of which I have paid off. I pay $141 a month with the ultimate goal of paying these off entirely. If at any point at time I became unemployed and/or refused to make monthly payments, the federal government would garnish my wages to pay off my outstanding student loan debt. This includes unemployment and/or medical disability if I were unable to work due to a worsening of my condition.

In addition to these challenges, I also have chronic illnesses that require prescription drugs to treat them and constant visits to a specialist to monitor my conditions.

You might say I have a vested interest in seeing a viable Universal Health Care plan passed. I’m not asking for anyone’s sympathy, just perhaps a understanding of why I want so desperately to see Universal Health Care sooner than later. And I’m far from the only person who would benefit from a workable program.

In two prior posts: here and here I have proposed prior solutions to establish universal care for every American. Suffice to say neither Obama’s plan nor Clinton’s plan is workable for me.

In an ideal world, the single-payer system proposed by Dennis Kucinich would be the most effective for us all. But I don’t need to inform all of you wise people reading this that what is ideal is not often what occurs in reality. What we often resort to is compromise. A single-payer system could be funded partially by rolling back the Bush tax cuts and ending the millions of dollars we pay every day in Iraq. But those alone would not provide the billions of dollar we would need to have a system that would be, at best, inefficient, underfunded, and another one of those dreaded unfunded mandates.

Passing a Universal Health Care plan is going to require a Grand Compromise between Republicans and Democrats. Even if in November we elect a Democratic President and maintain a Democratic controlled Congress (potentially even adding gains to the Democratic majority), the GOP representatives, Senators, and lobbyists who cater to members of BOTH parties will be hellbent trying to thwart every and all attempts made.

Expanding competition to include more than the four of five insurance companies who hold an effective monopoly over the health care industry is one solution. With expanded competition, prices would be forced by the nature of the Capitalist system to lower costs for everyone. The drawback of that approach is that the only way to increase competition is to decrease regulation. The Healthcare system in the United States is one of the most heavily regulated industries in the world. The reason Canada and other countries can sell prescription drugs cheaper than we can is because their Healthcare industries are not as tightly regulated as ours are. We pay $500 a month for a 30 day supply of medication when Canada pays 1/5 of that because U.S. residents absorb the medical and research costs involved in developing newer and more effective medications.

The drawback with de-regulation, one that Democrats would take serious offense to is that with de-regulation comes personal abuses. Flim-flam, fourth-rate, snake oil sales companies would spring up and certain individuals would unknowingly invest in policies that fleece them of their money while providing at best, insufficient, and at worse, utterly useless medical coverage. But in that case, consumer education and let the buyer beware comes into play. Free-market advocates, many of them Republican have long advocated these very same principles. Thus, they would be much more inclined to play ball if they won these concessions.

Democrats, rightly so, would cry foul. We need regulation, they say! Any time people are tricked and deceived by corporations is an utter travesty! And they’re right. But guess what? That sort of thing happens all the time anyway, under the current flawed system. Think about how many ways insurance companies deny coverage to needy people based on fine print and by claiming that they do not cover “pre-existing” conditions. The capitalist system ensures that bad companies go under with time because enough bad press ensues, enough people get angry, and these companies get enough criticism and lose enough business that they go out of business anyway.

A placated GOP would concede to de-regulation but deregulation alone is not enough to pay for Universal Coverage. Taxes need to be raised as well. Although Americans are notoriously loathe to pay raised taxes for anything, and this goes all the way back to the American Revolution, where a majority of soon-to-be Americans fought a war on the pretense that they were being taxed without representation, there is an ingrained repulsion in the American mentality towards increased taxation of any kind, regardless of whether or not it ultimately benefits us all in the end.

However, taxes will need to be raised. How much and on whom is a matter of debate. The fairest system would increase taxes directly proportional to income. Those living in poverty could not afford the increased tax load and would benefit from universal coverage the most. Not just because they are often the ones fleeced by greedy Big Pharma, but that with more money in their pockets, less bankruptcy and less poverty would result. These people would have more more at their disposal and no matter where they spend it, they would thrust more capital into the system and increase the economy. I’m not nearly naive enough to believe that people will best spend their money to benefit themselves. The money not spent on healthcare might be spent on cell phones, lottery tickets, or computer games systems but at least these people would be able to add money into the economy rather than draining it by contributing nothing at all.

I think taxation would then need to begin at a minimum income that would be adjusted for inflation periodically. Those who make more would ultimately be taxed more. That’s how we do it now to fund a variety of other social services. A Compromise that includes a Democratic tax raise in return for a promise of deregulation to appease Republicans is the best solution.

The problem then is that Big Pharma doesn’t want expanded competition. They want to make as much profit as possible. They have made billions of dollars of money based on sheer greed. Their lobby has an equal sway over representatives of both parties. The challenge will be to offer some kind of incentive to big Pharma because if they feel threatened, they will fight against legislation tooth and nail. Perhaps we could propose tax breaks to big Pharma. But that’s not fair, you say! These people make money hand over fist as it right now under the current system! Rest assured, Big Pharma, like all corporations, will do whatever it can to keep its monopoly and allocate money, propaganda, and resources to driving everyone else out of the business. The balancing factor is that with more companies in the insurance business, they can offer additional incentives the Big Boys can’t, like increased customer satisfaction, lower premiums, and additional strategies the Bigger Companies are not currently providing. That being the case, we all win, because effective strategies in business are inevitable absorbed into all because the ultimate motive in a capitalist system is to make money, and as much of it as possible. Competition often creates innovation.

Life is not fair and in order to get what is in the best interest of everyone, everyone’s going to have to get something out of the bargain. None of us is going to get exactly what we want exactly the way we want it. That is just the way life works.

1 comment:

Anonymous said...

CK - I'm with you on universal healthcare, and how to fund it, but we diverge at regulation.

There really is no such thing as a free market. Just look at the S&L bailout of the 1980s and the soon-to-be bailout of the big banks, well, soon. If free market rule was real, all of those banks and S&Ls would be going belly-up, as it should be. The economy would collapse, of course, but, hey! The invisible hand and all that.

The free market is a GOP myth. They bring it out when it suits them, but corporate america is always looking to suck at the teat of the treasury.

The part of capitalism that shoud take place is competition. With $ to be made, there should be many, many more competitors, and that is what drives the price down. Regulation is what should keep lead paint out of toys, and poison out of food. And when you are dealing with drugs, I think regulation is an absolute requirement.