HEALTH CARE

.HEALTH CARE:

BACKGROUND: There’s an interesting article on health care at http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande. It points out the tension between any idealized health care system and the need to build from factors already extant. For example, the course of events from the Great Depression through WWII made it necessary for the U.S. to go down the path of employment-based health care programs. Now that we're far down that path, many people have invested years of work in order to become vested in their health care coverage. Having paid their dues, they're far less prone to volunteer to pay tax increases to fund health care for those who have not paid such dues. Americans may idealize the perfect health care system, but there's no easy way to transition to it from the path we're already far down. Regardless of whatever ideal might otherwise be agreed upon, the path-dependent factors that already burden our system loom large against any sudden transition.

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IDEAL: Even so, it would seem worthwhile to envision what an ideal system might look like, so we can try to plan ahead and reserve ways here and there to make gradual transitions towards better sense. To do that, we need to look beyond brain-freezing pejoratives. Regarding brain freeze:   Few believe the national government should forego taxing residents in order to finance national defense, interstate highways, national standards for airline traffic, and inoculations of the general public in order to mitigate against epidemics. Similarly, there’s little reason to believe the national government should forego taxing residents in order to finance decent, civilized, national health care. Nor is there reason to believe that would unreasonably pick anyone’s pocket. Private companies still compete to produce weapons, contract to build roads, and provide airline services. Health care providers would still compete to market their services, even were payments for a floor of services to be made by some combination of national, state, and local governmental agencies. Britain, Canada, Australia, and numerous other nations manage to accomplish national health care without unreasonably compromising it. Yes, on behalf of plan users, the government would be in a strong bargaining position. But many people remain wealthy enough to enter into contracts for more exceptional services, so that progress towards increasing excellence in medical techniques would continue.

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REASON: If Rinos and corporatists can reasonably expect skilled factory workers to compete to market their labor to diminishing numbers of manufacturing and even foreign corporations, than Dinos and citizens can reasonably expect domestic health-care providers to compete to market their skills to diminishing numbers of governmental payers. Decent aspects of the market would be retained; indecent aspects would be reduced. Tax funded government would be incentived to control costs; the press would remain incentived to pressure providers not to unreasonably deny coverage; middling insurers would find markets for them to profit in by means other than denying health care to the least powerful. Assuming the U.S. could transition to a more ideal system, it could get the monkey for providing health care off employers’ backs and thereby allow American businessmen to become more competitive with offshore businesses that are not beset by such costs.

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BALANCE OF FACTORS: Regardless of system, there will always remain competing factors: How to attract good students to become good health care providers; how to disincentive illegal residents and malingerers from hijacking the system; how to overcome misleading pejoratives of purely profit-driven cronies. Indeed, it’s intuitive to any realistic thinker that some purely profit-driven cronies will always prefer that middling insurers remain involved precisely so that easy money can continue to be made by finding efficient ways for denying treatments to relatively powerless individuals.

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SLOGANS THAT FREEZE OUT THINKING: The soundbite pejorative (against requiring uncovered citizens to participate in a plan, pay for their own plan, pay a tax assessment to cover a government provided plan, or pay a tax penalty) is nonsense. The people are already mandated to pay assessments to cover public costs of health care!  They're called taxes. Public health care is paid for by public taxes. When you take advantage of emergency public health care, you're taking advantage of other people being required to pay for your coverage. They're called taxes. Unless you're an illegal alien, you pay them too. Just because the tax is called a mandate for individuals not otherwise covered does not make it other than a tax. If government can impose taxes to cover public health care, then it can impose a mandate to members of the public either to pay the tax (or fine), or to directly purchase their own coverage.

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PREPARING THE WAY: Enforce borders. Reform medical malpractice tort law. Make insurance policies for employees portable. Don't require employees with vested coverage plans to participate in taxes designed to cover government financed single payer plans for everyone else. Phase out copays on employer provided coverage. Over time, phase out requirements for employer provided coverage. Meantime, until transition is complete, the phasing and transitioning will unavoidably be fairly complex.

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OBSTACLES PLACED BY DUPLICITOUS CRONIES: Notwithstanding, even if Americans could reach consensus about an ideal system, how can they find a practical way to navigate towards it?   How can the fraud that passes for representation by the Allied Establishment of Dinos and Rinos ever be overcome? After all, health care is just one among numerous concerns for which ordinary, middle-class Americans are under the thumb of a corruptly allied Establishment of crony corporatists and collectivists, which controls most aspects of every such debate. The middle class can only restore good sense to the American system as it shucks off mainstream disinformation and begins educating itself. I wonder where Newt and Mitt REALLY stand on this?

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