The “public option”, which appeared dead only a month ago, is now gaining momentum among the public. The latest polls show Democrats in favor by 65 – 35%, while even Republicans prefer that option by a small margin. “Blue-dog” Democrats are running scared for opposing reform while their constituency favors it by a wide margin. Even still, Democrats from states like Nebraska (huge insurance industry) are opposing it. This is the worst of politics!
First, there are actually two distinct issues: health insurance reform, and healthcare reform. Fortunately, the president has at last begun to defuse the “health” issue by addressing his focus as “insurance reform”.
The insurance issue is easier to unravel. The “public-option”, which is gaining traction, is ultimately the only sensible way to go. This is not the scary thing that right-wingers portray---with all their slogans about government bureaucrats and “socialism”. The public option is merely an extension of Medicare, an extremely successful and popular program. True, it costs money, but the alternative, and the system we have now is much more odious and probably more expensive.
Medicare could be systematically expanded by lowering the eligibility age over time to eventually include everyone. As a concessionary alternative, the public option could be added to the present system, available to all, for a price. This would be OK, in that it would hold the insurance companies’ feet to the fire over prices and benefits.
Any plan that does not include a “public option” is a complete concession to insurance companies and the status quo. Right now we’re hearing of “mandates” to purchase health insurance. This would be the worst of all plans, leaving the insurance companies in control---leaving the fox in charge of the henhouse.
The best option, in our opinion, is the total public option---like in
The next issue, the cost, gets a bit stickier. There are many ways that our system produces out-of-control costs. One of the most egregious is the “multiple-test” scenario, in which doctors prescribe multiple tests to patients to cover their legal vulnerability. As long as insurance companies pay for the tests, the doctors prescribe more, running up their bills as well as those of the laboratories. This also brings more profit to the insurance companies, as a percentage of the total cost, all eventually covered by increased premiums. Another result of this scenario is an increase in the exposure of ill people to healthcare facilities, which are dangerous places for sick people! --- So these multiple, random, sometimes exotic tests run up everybody’s bills, covering the doctors’ liability, but have a negative impact on patients’ recovery. The government can control doctors’ liability through the plan, as they do in Medicare.
Another area generating enormous expense is the “final days” treatment for the very ill. There are a number of ways to handle this. The easiest is to pursue the so-called “death panel” approach (as described by Sarah Palin and other right-wing fear mongers) which really is only an avenue to allow people to prescribe how they wish their own care to be rationed in their final days.
Another way to manage this expense is to allow everyone to pre-determine his own level of “heroic measures” for their final days. There can be 2 or 3 different levels of procedures (and expense) available to everyone based upon their own decision made at some age---say 40 to 45. An individual would then pay a premium starting at that age to pay for their expanded level of coverage---the lower the age at commencement, the lower the premium. In this case, it would be important for all to know, including family members, what their relatives have chosen for their coverage.
Between a rational course of medical testing and a drastic reduction in the cost of keeping the very sick alive, a great deal of money can be saved. Further savings can easily be realized by cutting drug costs, as covered in a previous essay. Drug advertising on TV should be stopped, as it is outlawed almost everywhere else in the world. This alone would save billions. The existing prescription drug plan is designed to maximize drug company profits.
The most compelling piece of this puzzle, and perhaps the most difficult to unravel, is the issue of responsibility. Here we see the greatest possibility for savings. Who, after all, is responsible for our health? Is it our doctors? Insurance companies, the government? It is we, ourselves, who must shoulder the primary load of this responsibility. Can we ask society to take care of us when we don’t take care of ourselves? Yes, but not in good conscience.
The paradox of the “nanny state” is that while our government is proposing to insure our health, at the same time its policies now promote ill health. This hypocrisy must end. Then yes, government can definitely help us on the road to better health.
This begins with diet. Nutritious food must be available at an affordable price. Perhaps the most intractable problem is our ubiquitous junk food, so inexpensive that many are driven to eat it out of budgetary necessity. A lot of money can be saved by ending subsidies on the greatest culprits: beef and corn. Beyond, that, high enough taxes should be levied upon junk food to make it more expensive than good food. In this category we find candy, pastries, cookies, soda pop, chips, “twinkies” (processed foods), and fast-food restaurants.
This matter has actually appeared on the table. We saw a commercial on television in the last week with a shopping housewife, desperate over the possibility of a tax on her soda pop. One might think her children had to have this to stay healthy!
We need to face the consequences of unhealthy lifestyles. “Free” healthcare might be moderated by a “fat tax”, through which people assume responsibility for life-style choices (which cost the public dearly) by paying initially small insurance premiums for being overweight. These “taxes” should mount for those who continue to gain weight. A person 50 pounds over established weight standards may be asked to pay $50 per month---$100 for a hundred pounds, etc.
The beauty of such a system is that it serves itself. That is, the generation of income to pay for healthcare would come from these various (voluntary) taxes, which would “encourage” us to improve our health. This would presumably result in better health, lower health care costs, and bring the system to pay for itself.
Easy enough? Yes, but in addition to the Republican Party, considerable political forces are arrayed to oppose change from our present system. Write to your representatives.
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