Health Care Resolved; Two Sides

I recently read a piece at http://savannahnow.com/node/765648, a very well written Op-Ed, outlining with clarity of purpose, and the statistics to support the position, that America needs health care reform in 2009. I agree with the goal of this editor, as do I agree with President Obama. We do need a massive change in the way Americans receive health care in our country. What I do not buy, and the argument the left has successfully suppressed all year, is that there is more than one way to solve this problem. The leftists in Congress, along with the mainstream media, and most importantly, the president of the United States have successfully controlled the debate to include only their way or no way.

This is America. We have some major fundamental problems with the way health care has evolved over the last 40 years, and the only answer being put forward collectively by our political leadership is to offer socialized medicine modeled after England, Canada, or Switzerland. Never mind the fact that we aren’t any one of those countries. Never mind the fact that we have proven over the history of our nation that we have the entrepreneurial spirit to govern ourselves, by and for ourselves. There is a way, no, there are many ways we can solve this very real issue without rendering unto Caesar, that which is ours. And make no mistake; putting the federal government in charge of the health care system will enable the government to control, ultimately, every facet of our lives.

About this time, those of you reading this who are in favor of health care reform, in the sense the debate has thus far been defined, have made up your mind that I am about to spew the same argument we’ve been hearing from the republican party, and you likely won’t even finish reading my thoughts. If so, then so be it, but if you can spare a few minutes, then hear me out. There is a distinctly American way to solve this problem.

Before a solution can be devised we must first understand what has brought us to where we are. The American health care system, mostly employer provided, for those who have sufficient insurance at any rate, began in a different time. The time included the fact that the majority of Americans worked for large companies who provided pensions, health care, and the promise of a life long job, if one were so inclined, or as members of a labor union. This worked better than countries that had nationalized systems until major change occurred in the landscape of America. First and foremost, the government instituted Medicare, then Medicaid. On the face of those two well intentioned programs there should not have been any major issues, but on the one hand, when you leave the government to their own devices, they can screw up anything.

The government determined that to provide insurance to our elderly and infirm, they would have to implement a massive paperwork trail, as well as determine exactly what doctors and hospitals should receive as remittance for the services they provided that were paid by the government. Without going into thousands of pages of rules thrust onto the medical industry, the results were fairly predictable. Medicaid has evolved over time to pay the medical industry about 80% of the costs of providing the care, and Medicare pays about 90% of the costs to the industry, while both add substantially to the cost of doing business for doctors and hospitals. The required paperwork is not only onerous, but absent of logic in most instances, thereby requiring highly skilled office workers to get even the 80 or 90% of actual costs paid by the government, minus the cost of the highly skilled office workers of course.

Being the business people they were, and unable to fight back against a government rife with bureaucrats who could sit on claims for months on end without payment, the hospitals first, then the doctors devised methods that have allowed them to collect an average 135% of the costs of supplying health care to those of us who still have medical insurance, either provided by our employer, or paid for as a private plan. At the same time, our Congress has made it literally impossible to obtain private insurance that is affordable by being loyal only to those lobbyists who pay huge sums of money into their reelection coffers. No one has ever united a lobby for just regular folks, and our Congress is polluted with elected officials who have made laws that allow them to take bribes of cash in exchange for passing laws favorable to the groups paying the bribes. This is true across every part of our government, but has proved to be the place that most damages the daily lives of Americans. Henceforth, we have finally come to this point in our country where we are finally having the great debate, and we are debating the wrong issue.

We should be debating the system that allowed the health care industry, as well as every other major form of expenditures in this country to be managed by laws passed by those who make Al Capone seem tame by comparison. Why is that you can’t purchase a health care policy from a company outside the state where you reside? You can buy most things you want or need in any state, whether or not you live there. The only things where that isn’t possible, are those items regulated by the federal government, such as health care, in this instance. There are others, like guns, but that is a subject for another day.

Businesses get huge tax incentives for providing health care for their employers. Those incentives are based on the premiums they pay per employee. Why then, can’t individuals gain a tax advantage for paying those same premiums? The question is of course rhetorical, but I will answer it anyway. There is no lobby giving individual Congressman money to pay for the favor of giving the tax incentive. Everything Congress does to benefit any group of people must be paid for, written up, and explained in detail, by experts from the organizations wanting the favors.

That is how our government has evolved. The Congressmen, nor their staffs, are even capable of implementing the laws that the various lobbies require and pay to have passed. The Congressmen don’t even read the legislation. We didn’t find that out until this year, but it has been that way for a long time. You can see the surprise and frustration on the faces of those legislators who have been called out for not reading the bills. It is inconceivable to them that we would even expect it. They have operated for so long, in the manner the government has evolved, that the members currently in Congress were not there when it was any other way. That is just the way they were taught, even the ones who came before them didn’t likely know the difference. There are a few, still serving , who have been present for the entire sordid affair, such as Robert Byrd, Ted Kennedy, as well as others not so well known, but for the most part, the legislators we have today truly think they are doing what is expected of them. To bear that out, we rarely know any better either, and have accepted this manner of governance as a matter of fact, for decades.

Everyone of our current Congressman, with a few exceptions as always, have purchased their position, not only through one election, but as a result of a career of doing political business in such a way as to be expert at listening to special interests, and voting on the laws and regulations paid for and created by the special interest groups that have good financial reasoning for controlling the laws that get passed. We therefore are governed by 535 mob bosses, except that not one of them understands their business the way mob bosses understood crime. We have to start fixing health care by fixing our elective representative government. We have to vote out the incumbents. We have to implement term limits, and we have to start over with respect to both the House and the Senate. In the meantime, we can start forcing our current legislators to do something productive, and pass laws that will benefit the people, not the special interest groups, and starting with health care has now become the most righteous place to begin.

There are many ideas out there on ways to solve the health care issues that make insurance unaffordable, that many times bankrupt hard working Americans who either can’t afford coverage, or roll the dice, don’t purchase even catastrophic coverage, and thus suffer failed lives when a major illness or injury strikes. We can fix that without becoming Socialists. The government has not been putting forth any ideas for change until now that the left has taken control of both branches of policy government. The left has always been willing to create a social democracy and become the ultimate nanny state. They just haven’t had the political clout to get it done before now. Since they now do have the power, the GOP is offering up some rather good ideas, that should have been done decades ago, except that no one was paying them to implement the ideas, and no lobby had sufficient interest in solving problems for individual American citizens.

Now that the conservatives, or fake conservatives have seen themselves soundly defeated in two straight elections, and now that big pharma, the insurance companies, the AMA, and the BAR are helping the democrats write the legislation that will end their gravy train, and as they are scrambling to minimize their losses, we are getting some decent ideas of ways to solve the inconsistencies with the basic premise of our health care policy in the United States. They certainly aren’t going far enough though, and are doing their best to minimize the effect on the Congress' own gravy train, notwithstanding that of the special interest groups. Below is a list of ideas I have either taken from conservatives, consumer interest groups, and some I have thought of on my own. It is by no means an inclusive list of ideas, as there are probably many other ideas as good or better than these. They do, however, provide methods, for solving the majority of our health care issues, and not turn over control of our health care system to the government.

Government run health care would result in most of the dangers considered by the left to be scare monger tactics. The fact is, if we turn over control of health care to a government system, immediately place an extra 47 million people into the system, while adding no doctors, and cutting expenditures, the only way it can possibly work at all is to ration health care. That isn’t hate speech. It certainly isn’t a lie, hysteria, disinformation, or racist. It is simple logic. Any plan that works, with respect to any subject, with respect to anything in life, requires the numbers to add up. In the case of government run health care promising to cover an additional 47 million people, while being deficit neutral, and not rationing care, just simply defies logic. It cannot be done. We can either spend trillions more dollars, or we can ration care, if we are to make a government system work at all.

There are alternatives though. It doesn’t have to be the government’s way or the highway. We can’t follow those on either side who refuse to listen, or who demonize those who aren’t in agreement with their position. If we are to have a debate, and if we are to solve the problems we face, we must first listen, and think for ourselves. Our government has failed us. We now must step up, take charge, and do the things that should have been done many years ago. Think about these ten things, how to get them accomplished, and then add some of your own. We can make the Congress do our bidding, but only if we are united, remain calm, and insist that the government take action based on the good of the people, and not the good of the government. Our actions do not have to grow government to solve these issues. We can:

1. Enable cross state health care insurance competition
2. Enable equal tax treatment for private pay health care insurance VS employer provided insurance.
3. Enable Tort reform for medical malpractice litigation.
4. Change patent guidelines for pharmaceutical companies to lower drug costs.
5. Incentivize medical students for taking up family practice and/or Internal Medicine.
6. Enforce immigration laws currently on the books
7. Increase minimum income requirement for Medicaid
8. Require insurance providers to accept high risk individuals through pool, similar to auto insurance
9. Regulate insurance industry at federal level, rather than individual state
10. Incentivize preventive health measures with declining premiums

With respect to number 1 above; competition is the cornerstone of prosperity in this country. The government has stifled competition, to individual states, only because it is in the interest of the insurance companies, and to the detriment of the people. The arguments I have heard as to how this would just result in higher costs for people in the states who currently have affordable insurance are ludicrous. IF XYZ insurance is making money now with lower rates in a state with minimal customers, they will make significantly more money as they add more customers. It will also force ABC insurance to lower their rates to compete and keep their customers, rather than allow XYZ to poach their customers. This is American as it gets.

Number 2 is a no brainer. We currently allow businesses a tax incentive for every cent they spend on employer health care coverage, and yet those people who are self employed, musicians, artists, and others who have the nerve to strike out on their own must pay higher premiums, with no tax break for the same or usually inferior coverage as do those who choose to work for someone else who has the nerve to strike out on their own. What is the logic in that? There is no logic. Businesses were given these tax incentives in order to insure Americans at a time when the vast majority of citizens worked for large companies, or were in trade unions. That just isn’t the case anymore, and there is no lobby for individualists in this country. The Congress should have been taking up that job from the jump, but they didn’t, they haven’t, and they don’t really have any intention of doing it unless forced to take action, and even then we will have to hire people to train them to write the legislation, as there is no lobby with the expertise to write and present it to them.

3. I’m not sure just how much Tort reform will reduce the overall cost of medical care, but it would be huge. Currently doctors and hospitals pay exorbitant premiums to those same insurance companies who cover health care, and the lawyers make a ton of money in both nuisance, as well as, well founded cases of malpractice. The not knowing how much a jury will award a defendant drives these costs through the roof. The answer is to set maximums for different levels of injury, specific time frames of recovery, and perhaps even more important, punish those who bring nuisance cases to court by forcing them to pay the defendants attorney fee, the court costs, and a substantial fine. The lawyers in Congress will never do this unless they are left no other choice. We have to take that choice away and force them to do it.

4. Research costs for new drugs are substantial. The pharmaceutical companies must be allowed to recover those costs, or they will stop the research. We must keep that in mind while awarding patents, but we must also weigh that with the cost of medical care. The rest of the world is reverse engineering America’s discoveries, and selling the generics for a pittance in order to take care of their citizens. We must tie the actual costs of individual drug research to the amount big pharma is allowed to recover. This is a difficult problem, but President Obama was able to buy off the pharmaceutical companies by limiting their hit in his health care bill to $80 billion. That shows that they have room to negotiate. We have to make the same, or a better deal for the citizens without government control of the entire system. After all, this is America, and we don’t need to socialize an industry to make it work. Our country was founded on a set of values and a proposition for equality and freedom, with minimal government interference. It is the best government ever devised. Why throw it away now?

5. We don’t have enough doctors to take on 47 million more people, particularly with respect to general practitioners. We do have an abundance of specialists. We need to offer incentives for those already in specialties, as well as students to go into general practice or Internal Medicine. Ignoring these facts will result in long lines. That isn’t spreading hysteria. It is simply recognizing the issues before us. Since we don’t currently have a really good preventive health care system in the United States, and do have a lot of specialists making a lot of money, and since as a result there is very little incentive for doctors to take up general practice, we have a severe shortage of just regular doctors. The ones we do have cannot take on 47 million more people without hugely significant issues. The government pay health care plan is not addressing these facts.

6. This is an emotional issue, and many liberals will not agree. However, of the 47 million people without health insurance in this country, there is an estimated 10 to 15 million of them in the country illegally. I cannot vouch for these numbers, but I can see, and every time I go to Walmart I can see that there are a significant number of people living all around me who cannot speak English. Some percentage of those people are in the country illegally. While I recognize we are a country founded on immigration, we do still have a responsibility to enforce our laws. We also have a responsibility to those who immigrate legally, and should not allow those who break the laws to obtain advantage over those who obey the same laws. Both the democrats and republicans have refused to enforce our immigration laws, and to protect our borders from penetration by illegal immigrants. This is a failure on the part of Congress we have allowed to go on for decades. It is time we insist something be done, and one of the many reasons to vote out every single incumbent in the House and the Senate. 47 million can be reduced to 37 or even 32 million, depending on whose numbers you believe. Even if only 5 million are here illegally, it will still help defray the costs of providing health care to those who show up in Emergency rooms around the country on a daily basis. If you have gone to an Emergency room in a major city in this country in the last 10 or 15 years you have seen for yourself who is there, and what it is costing us.

7. There are currently a lot of Americans who do not have health care offered by their employer, who cannot afford to purchase a private policy for their family, but still make more per year than the maximum allowed to qualify for Medicaid. A lot of people in this group are construction workers, who tend to earn much more on an annual basis than they can count on in monthly payments for insurance premiums. We have to revisit these numbers on a regular basis to ensure these hard working people don’t ruin their lives with an illness or accident, when they are already at the low end of the economic scale of those not considered impoverished, while those with no job get free medical care. This is the result of Congress not thinking through the legislation and regulations they pass along to their constituents and it is the constituents who are hurt by this particular brand of incompetence because they don’t have a lobby to protect their interests. Are you starting to see a pattern here, especially with respect to lobbyists?

8. Everyone is required in most states to carry car insurance in order to register their car, and in some states to get a license. This is basic civics 101, and why don’t we use the same system to insure people for health care? Again, the insurance lobby for automobiles wants to insure every single car on the road, and the people who are insured demand they be protected financially, from people who may run them over. With respect to health care insurance, those companies have no desire to collect premiums from people with pre-existing conditions, even minor ones, like pregnancy, as pointed out in the aforementioned Op-ed. In most cases I am not for government intervention, but with respect to health insurance, the providers have proven themselves to be unworthy of regulating themselves. They will require that the government force them to take the good with the bad, even in times when they will likely lose money. For these individuals, they will pay higher premiums, but it will be a regulated amount, and the government will not permit any individual to be priced out of insurance, or refused coverage due to any condition, either previously existing or contracted after having written the policy. This will necessarily increase everyone’s premium to some extent, precisely as it does with car insurance.


9. Primarily because of numbers 1 and 8 above, we cannot burden insurance company’s regulation in every single state. We must therefore assume insurance regulation at the federal level. We already regulate the financial industry at the federal level, and taking on insurance, while burdensome, especially in the beginning, is an evil we cannot get around.

10. Some of the arguments, from the president especially, but from the left in general do have a ring of truth to them, even though the government pay plan would not necessarily result in a healthier population. However, we could incentivize healthy behavior with a decrease in premiums, regulated by the government in 9 above, for those people who take their personal health seriously. Instead of punishing bad behavior, as in the fat tax, and other things the government has recommended, and even implemented in New York and other states, we can lower health care premiums for those who do not smoke, for those with cholesterol and triglyceride numbers in the pink, or even for those who have taken all the preventive precautions and office visits, while avoiding having to see a doctor for illness and injury. This would have the effect of lowering premiums for the young, for the middle aged, who took care of themselves while young, and even for those who don’t engage in high risk behavior resulting in broken bones, cuts, and other accidental health care visits.

The 10 ideas I put forth here are just that, ideas that do not require a complete government takeover, although they do represent quite a bit of government action, most of which they would avoid at all costs, other than the failure to be reelected. There are only two ways to get Congress to act. One is the pay them for voting the way your particular interest group wants. The second is with direct and demonstrable proof that failure to act will result in likely defeat in the next election. This only works with House members, and any Senators who are in their last two years of their 6 year term. Anything beyond two years, and legislators have learned that the people forget. We can’t afford to forget ever again. Barack Obama has appeared in a time and place that has given him the opportunity to put in place a Socialized Democracy in this country, replacing the republic so many have fought and died to protect. We cannot allow him to succeed. He has chosen the health care issue, because it is our single biggest failure as a nation. It is a black eye on our culture to have allowed our health care system to erode to such a low point of our society. We need to fix health care, but we don’t have to become socialists to do it. We can fix the health care system and rid ourselves of a Congress out of control and out of touch, all in one fell swoop. We only have to speak with one voice, with one purpose, and stop this left/right fight amongst ourselves. This is America, and in spite of the health care embarrassment, we are still the greatest nation on the Earth! We can keep it that way.