Another reminder: health care is NOT a right
I’m going to turn north of the border – the border between Maryland and Delaware, that is. But the topic I’m discussing here smacks of the differences between our country and the nation to our north, Canada. (That’s just a reminder for the few geographically-challenged readers who come to monoblogue. I wonder if they still teach that in school sometimes.)
Jack Markell is such a good writer as far as conveying his stance on the issues that I had to add a category to deal with Delaware politics. In this case though it also has application to our side of the fence because one aspect of the special session we in Maryland just endured was allocating $600 million in money we supposedly didn’t have to cover another 100,000 Maryland residents with health insurance. If you use that dollar figure as a guide, knowing that Markell claims that there’s about 100,000 in Delaware without insurance, that’s a whole lot to add to the budget of a state Delaware’s size (a population roughly 1/7 of Maryland’s.) I give Markell some credit for not simply wanting to throw money at the problem but coming up with a palette of ideas he sees as solutions.
What Jack wants to do can be summed up in a few short bullet points:
- Sign up all those who are already eligible for state programs;
- Allow families to purchase their health insurance through a market regulated by the state;
- Require employers to either have insurance or contribute to a state fund;
- Require insurers to guarantee coverage for individuals and individuals to have insurance of some sort.
The entire plan is here, but I think I’ll tackle these issues point by point.
In the first case, there’s a lot of people who would be considered underinsured. They may have insurance through their employer but do not make enough to be past the threshold that the state uses to determine eligibility. It seems to me that what Jack is suggesting is similar to a move Wal-Mart was castigated for – encouraging people to use the state as their insurer rather than their employer. That point is reinforced when Markell talks about “presumptive eligibility”, when those who apply will be presumed to qualify and allowing schools and preschools to screen children to determine whether they qualify. (Another reason kids may be geographically challenged, since that process takes money away from what schools are supposed to do.) Further, as I’ll argue regarding subsequent points, the incentive for insurers to do business in the state will wane despite the additional pool for coverage.
The second point would add a number of hitherto uninsured people to the market; however, the market would not be a free market that just anyone can jump into. As Markell writes:
Standards for health care plans offered through the Marketplace would be set by a Delaware Diamond Board. There would be a benchmark comprehensive plan that would cover primary, preventive, acute, and hospital care, with an emphasis on preventive care and disease management. Health care plans would vary in the level of benefits offered and out-of-pocket costs. The out-of-pocket costs for the benchmark plan would be capped to ensure affordability and designed to encourage smart preventive health practices and treatment. (Emphasis mine.)
In other words, the amount that an insurer can be reimbursed by the user is limited, so the profit margin either has to come from the caregiver or the state. While most think HMO’s and health insurance companies are purely evil, they do have a right to a return on investment too. And chances are they’ll put the squeeze on hospitals and other providers.
The third point has already been tried in Maryland. Anyone remember Fair Share? I know I do, and in the early days of monoblogue it was a frequent subject. But instead of a statewide edict affecting only companies who employ over 10,000 and don’t devote a certain percentage of their employee costs to health care, Markell goes for pretty much the whole enchilada:
To level the playing field, employers with 10 or more employees will be required to pay a fair share fee for each full-time-equivalent employee who is not covered through the employer or through another insurer.
Not only is that a job-killing idea, he even uses the same term as Maryland did! While he claims that he’ll start with companies with 100 or more employees, it may behoove you if he becomes governor and you have, say, 12 employees, to lay off 3 pretty quickly. True, he may level the playing field in Delaware but all that may do is drive business someplace else.
Finally, Markell decides to channel a portion of Mitt Romney’s Massachusetts plan, requiring all to have health insurance. It’s not clear whether Markell would use the same tactic on scofflaws (an additional fee paid yearly with their income tax) but what Jack wants to do is apply the force of government to what should be an individual decision. Not only that, he also places the restriction on insurance companies who now would be forced to cover all who apply. That is sure to drive insurance companies away from the Delaware market, and eventually when no one is left to provide private insurance it will fall on the shoulders of the state government to do so. It may take a couple decades or so, but incrementalism is how the liberals have played this game for the last 70 years.
And I haven’t even gotten to how Markell plans on paying for this. You should already know that, being a liberal Democrat, he has one target in mind:
An additional 50 cent increase in the tobacco tax would raise nearly $38 million in additional revenue, result in over $85 million in long-term health care savings, and save 1200 Delaware kids from an early smoking-related death.
It’s a tobacco tax increase – for the children, of course! After all, Delaware “only” ranks 21st among the states in their cigarette tax rate, and I honestly don’t think those on the “progressive” side are satisfied with their tax rates until they hit number one. He also thinks that Delaware doesn’t hit up the feds for their rightful share either. Much as Maryland’s budget, a large chunk of the First State’s comes courtesy of taxpayers in all 50 states.
But a post of this nature isn’t complete to me unless I suggest some alternatives. Here’s some of where I think this issue should go. In that piece, I did suggest that each state should be its own laboratory for change, so Jack Markell is within his right to suggest changes occuring within Dover and not by some bureaucrat a few dozen miles west in Washington, D.C.
What’s missing from his plan in my view are measures to bring more competition to the marketplace. Nor is there room for something I consider as more of a common-sense portion of the solution, health savings accounts. Instead, Markell chooses an incrementalist approach where eventually incentives for insurers to enter or stay in the Delaware market will dry up, leaving taxpayers and employers – those who create the jobs he vows to bring to Delaware - holding the bill.
It’s too late for us in Maryland to change the path we’ll be on until at least 2010. But those of you in Delaware would be wise to learn from our mistakes. I often note that Maryland is the canary in the coal mine when it comes to so-called progressivism run amok, so you folks north of the border need to pay attention and take the opportunity you have to keep your state more free than the Free State.
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Agreed, Michael. Healthcare is not a right.
The controversy, issues, questions and costs of ‘healthcare’ affect every person in the United States (citizen, illegal or other status). I liked your analogy to 6-degrees-to-Kevin-Bacon – most national issues relate to ‘healthcare’; education, military spending; border control to name a few. Multiple semantic gymnastics have contributed to the vortex fallacy that ‘healthcare’ is a right. Using the term ‘healthcare’ for medical care misrepresents the services of physicians. And yet, physicians are the traditional entry point for care. Physicians have held onto traditional power in services – prolonging a praternalistic attitude toward patients and promoting learned helplessness among patients. Why should patients take responsibility for their own health if it is the doctor’s job to cure them? Back to semantics, using ‘medical care’ over medicine also contributes to the afformentioned line of thinking. Why should patients take responsibility for their own health if it is the doctor’s job to take care of them?
Unfortunately, physicians as a group did not ‘mind the store’ well for managing the business end of medicine. When private insurance became the responsibility of the employer – when it began to appear that someone else paid for medicine – parallel in timing to the idea that the government should form a safety net for the unfortunate poor (disabled, minority, young) health became someone else’s responsibility.
While all are affected in some way, individuals who have chronic, permanent or progressive conditions/illnesses display the dysfunction of any government-sponsored ‘healthcare’. These people LIVE in the ‘healthcare’ world, interacting with multiple physicians, other providers and insurers on a regular basis. I specifically speak to parents of children with disabilities through my blogsite http://www.therextras.com. In small bytes, I hope to help some of them through the medical maze currently in place.
I left a comment last evening, but do not see it posted. What did I do wrong? Barbara
Barbara,
You did nothing wrong, I just wasn’t online to moderate comments between yesterday evening and just now. Most times I don’t check my site during workdays because I’m at work and I don’t maintain moderator access to it from my work computer.
Hope that clears this up for you any anyone else who leaves comments.
Thanks, Michael. I’m new at leaving comments.
No problem, particularly when you leave excellent comments as you did above. I love ones that advance the conversation.
[...] Again, Jack has a comprehensive plan and in turn I’ve already written a piece on it. Admittedly, my criticism of Markell in this case is Maryland-centric because we had a [...]
[...] Again, Jack has a comprehensive plan and in turn I’ve already written a piece on it. Admittedly, my criticism of Markell in this case is Maryland-centric because we had a [...]