From a one time alternative presidential candidate, here is a practical idealist's plan for U.S. health care reform. by John Kusumi
(centrist)
Thursday, July 30, 2009
Being practical idealist, I am both socially liberal and fiscally conservative. On health care, I believe that America needs three things: access to coverage for all; the end of dirty tricks on the part of insurers; and affordability.
On coverage, I would have America step up to the plate and say, "Yes, we do care about the least among us. Yes, we will cover their health care needs." And yet, I think there should be a quantitative target on the wall, because sound objectives are measurable and dated. When JFK told us to go to the moon, he also said to do so within ten years' time. I think that we should cover all uninsured Americans, and do it for no more than $100 billion per year.
Let's face it. There are 47 million Americans without access to health coverage, and that leaves 260 million Americans who *do* have coverage. The problem of access to coverage is affecting the former group, not the latter. Hence, access help should target the former group, not the latter.
As a result, my answer is not single-payer, universal health care. When the private sector can get the job done correctly, it should be free to do so. Above, I mentioned two different groups. The access problem affects 47 million (let's say 1/6 of the population), and the dirty tricks problem affects 260 million (let's say 5/6 of the population). Instead of one health reform plan and bill, this should be two -- one for public sector reform, and one for private sector reform.
I happen to think that the simplest answer to add coverage for 47 million people is to raise the threshold of eligibility for Medicaid. Medicaid can and should be made free to the bottom 1/6 of earners (based on household earnings rather than individual earnings). And, the prescription drug benefit that now accompanies Medicare can and should be extended to those on Medicaid.
For 47 million people, that means "problem solved," and I bet that the cost will fall within my $100 billion target. (Disclaimer: The government can always escalate costs to an insane level. I thought the Iraq war should have been fought for $75-$90 billion, but the government made it cost over 10 times that amount. So, I refuse to be blamed if a Medicaid adjustment costs more than $100 billion. How I would do things is one matter; how *they* do things reflects brain damage about which you should ask them.)
The next problem is that of dirty tricks on the part of insurers. The U.S. Congress has the power to regulate the insurance industry. A bill should say that we're changing the ground rules for insurance firms. New rule: "No price - nor coverage - discrimination for sick people and those with pre-existing medical conditions." That simple rule would stop insurers from denying coverage and/or jacking up rates for people with pre-existing conditions and for those with coverage when illness strikes.
The cost of extra Medicaid is to be borne by the public sector; the cost of the rule changes for insurers is to be borne by the private sector.
After access and dirty tricks are addressed, the next problem is affordability. The private sector reform bill should have additional rules for insurers. "Co-pays may not exceed $200 per month, and deductibles may not exceed 10% of the patient's actual household income last year. For whatever reason, patients may not be burdened beyond the amounts implied above."
For one more interesting boost for health, the government should require landlords to remediate toxic mold conditions in all rental units. That mandate would actually create some jobs, along with providing a more healthy environment for renters -- some of whom are immune-compromised and have massive health complications arising from unhealthy buildings.
Some wag will read this far and say, "Well, John, how is it paid for? You haven't specified the source of $100 billion annually." Personally, I think that it is easy for the USG (US government) to find $100 billion annually. Since I favor means-testing entitlements, how about means-testing Medicare? --And if that doesn't produce an entire $100 billion, then how about a haircut for the military? The military spends more than six times this amount annually these days, but I think that they should be able to keep the lights on (in peacetime) for a "mere" 3.25% of GDP. If the USG changes its priorities, it can find $100 billion. Q.E.D.
Note that my plan, above, has no new mandates for employers, and no requirement for individuals to buy anything. Medicaid would simply be there for people when they need it. Government and insurers would change their ways, but not doctors or hospitals. All that I advocate is simple changes to the existing health infrastructure. The insurance industry would be reformed, but it would dodge the bullet of a prospective single-payer, universal health system. I have called myself a "practical idealist," and I think the above shows a practical side and eschews the single-payer magic bullet that some progressives (or idealists) would prefer to read in my advocacy.
For a postscript, I would be able to write an article about how to fix the economy for "only" $300 billion. However, they've already wasted more than 10 times that amount, so I really think that our political leaders ought to be perp-walked into jails for crimes against America and the American worker.
Also, here's an idea to boost health for civilians in other nations: Discontinue land mines, cluster bombs, and weapons with depleted uranium. They should be taken out of the American arsenal, and in the absence of same, I think that American leaders should also be perp-walked into the Hague for crimes against humanity.
Do you suppose that I should write those "postscript" articles, or keep that stuff to myself? ;)
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The "47 million uninsured" number may be somewhat misleading. About 10 million of those are illegal aliens. Another 20 million make over $50,000 per year and could afford health care insurance but for whatever reason prefer not to. Others could be covered by medicaid. So the real problem may be more like 10 million, rather than 47 million. [link edited for length]
These politicians voted Against the Nathan Deal Amendment, that would Prevent Health Care Benefits to Illegal Aliens. Simply put--it's not their BLOODY MONEY! So what! Do they care if taxpayers have to foot the behemoth bill, for anybody who snubs our laws and enters a sovereign country called America? The nationwide parasites are --CHEAP LABOR--businesses who could care less, because they pile up enormous profits. The corporate hierarchy have been having a field day--FOR DECADES. A foreign national gets hurt, their service manager or whoever the underling is, drives the maimed person and relinquishes any responsibility by dumping them on the emergency hospital entranceway. BINGO! nothing to pay!
Perhaps Americans should find some old shoddy clothes, no shave, no haircut and enter every emergency room in our country in the millions? Speak a lot of gibberish and carry no identification with a small splinter in their finger, a touch of a fever or any minor condition. By federal law the hospital will have an emergency on a--EMERGENCY. I am afraid Americans have been Lemmings going over a proverbial cliff, since who knows when? We just keep paying and paying even more to the IRS, to support--ILLEGAL IMMIGRANTS. Try getting free health care in any other country, other than societies in the European Union? A FAT CHANCE! We are literary being taxed to death, to give welfare to the business overlords.
Even our Democrats who are trying to engineer health care for every American---INCLUDED 20 PLUS ILLEGAL IMMIGRANTS AND THEIR LARGE FAMILIES. Here are 29 Judas Iscariot's, who sold the American people out--for a lot more than 13 pieces of silver? HUNDREDS OF BILLIONS OF DOLLARS EVERY YEAR. Capps (D-CA), Eshoo (D-CA), Harman (D-CA), Matsui (D-CA), McNerney (D-CA), Waxman (D-CA), DeGette (D-CO), Murphy (D-CT), Castor (D-FL), Rush (D-IL), Schakowsky (D-IL), Braley (D-IA), Sarbanes (D-MD), Markey (D-MA), Dingell (D-MI), Stupak (D-MI), Pallone (D-NJ), Weiner (D-NY), Butterfield (D-NC), Space (D-OH), Sutton (D-OH), Doyle (D-PA), Gordon (D-TN), Gonzalez (D-TX), Green (D-TX),Welch (D-VT), Christensen (D-VI), Inslee (D-WA) and Baldwin (D-WI). I'm afraid I would be banned if I used the right epithet, when leaving a comment for these so called lawmakers?
These are the betrayers of--ALL--taxpayers. These 29 traitors gave illegal immigrants the right to pilfer your billfold and purse, while they sit in their Washington office collecting their 6 figure salaries. REMEMBER THEM AND THROW THEM OUT! DEMAND NO AMNESTY! NO FAMILY UNIFICATION KNOWN AS CHAIN MIGRATION! BUILD THE ORIGINAL FENCE! NO MORE HEALTH CARE OR ANY OTHER KIND OF BENEFITS FOR ILLEGAL IMMIGRANTS. CLOSE THE BORDER AND STATION THE NATIONAL GUARD. $2.5 TRILLION DOLLARS, JUST IN RETIREMENT BENEFITS? Learn uncorrupted facts at NUMBERSUSA. Copy, Paste and Distribute freely
This may be why I'm not a libertarian, even though I have some sympathies and leanings in a libertarian direction.
I think it's true that we must close the borders. As the place becomes more of a welfare state, it is a honeypot to attract immigrants. I'll take the legal ones, but not the illegal ones.
However, libertarians seem to be the crowd that says, "there's no room at the Inn." As we know from lore, this is why Jesus was born in a manger.
Libertarians seem unhinged when it's about money, to wit-- "Your poverty is your fault! Tough luck, sucker!"
We can explore these thoughts. Above, I said that I would take the legal ones, but not the illegal ones. But that's at the border. I will agree that illegal is illegal and not argue that indeed, we need to close the borders. But, knowing reality, there will still be some who are already here, within the borders. (Today's reality is that there's too many in that circumstance, I agree.) The thing is this: for an example, it doesn't even have to be an illegal. Imagine that there is an uninsured tourist within U.S. borders, and she is a woman who is going into labor and about to give birth.
At the entrance of the hospital, there stands the writer of the comment above. "No dice, lady!" So, what is the directive? Would he tell the woman to give birth on the sidewalk? Or perhaps say, "I know where there's a manger. It's two blocks down, turn left at the Texaco."
But there's something else to this matter, because on one hand, there are tangible physical events, and on the other hand, there are information events that entail money and finances.
Quite regardless of what country and what century is involved, to give birth means to give birth. There will be the physical occasion of a woman on her back, some fluids, and hopefully a healthy baby. A bed and some care are in order.
I assume that libertarians are human too, hence the indication of physical necessities is understandable. In theory, a libertarian can stand there and say, "It's not my job to provide those physical necessities!" That's true if you're in a different line of work. However, for hospital workers IT IS their job to provide such care.
The writer above, in the name of his ideology, would jump in between a doctor and patient to say "I forbid this next move! It's not paid for and the paperwork doesn't exist in triplicate with all in order at libertarian headquarters!"
In that instance, the correct thing to do is to call the police, to haul away the libertarian obstructionist who wants to interfere with a doctor's job and a woman's birth process. Heck, the more I think this through, I am becoming happier and happier that libertarians are not the governing authorities around here!
Okay, at this point in my example, the libertarian has been removed for impertinent harrassment or disturbing the peace, and the woman has gone inside and given birth.
The physical events are done with, and what's next is the information event known as an invoice. From the first two paragraphs above, it's evident that the writer objects to PROFITS on the part of "business overlords," "cheap labor businesses," and "the corporate hierarchy."
When taxpayers pay that invoice, true enough there are two components: cost of goods sold (CGS), and profit. Would the writer object less if the profit piece was saved, so that the cost to taxpayers is less? Well then, that is a good argument for government-run health care, because government can do things for the CGS number without the profit number. But somehow, I don't think that libertarians are in favor of that idea, either. So really, there's no solution forthcoming from them, just an ideological opposition to the spending of tax revenues. Truly, if the uninsured tourist has insufficient funds, then "the manger" (or the sidewalk) seems to be the libertarian answer in this instance.
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