I’ve said it before and I’ll say it again: Health care is NOT a right.
This chapter may sound suspiciously like my last chapter on Social Security because the solution is pretty much the same. It’s time to get the federal government out of the health care arena too. But instead of a gradual sunsetting of the program as I suggest for Social Security, the Medicare program would likely be better served by turning it over to each individual state and letting them set their methods of payment and such. Thus the federal government wouldn’t be sending states billions to assist with their existing health care and health insurance program costs. Because many states require a balanced budget (like Maryland does), it will bring a debate on what should be done about the issue of government involvement in health care and how to pay for it to each state capital, instead of just depending on the bottomless well of the federal government to cover their shortfalls as they currently do.
Some states have made attempts to change the system by focusing on the health insurance aspect. Probably the most well-known is the Massachusetts plan that Presidential candidate Mitt Romney sheperded through. In simple terms, Bay State residents either need to have insurance through their employer, through the state (for unemployed or poorer residents), or pay a penalty with their income taxes. Many compare it to a state requirement to carry auto insurance, but there’s one piece of the puzzle that tends to be forgotten. People can get along in life without owning a car (hey, the Amish do it) and, particularly for those young and relatively healthy, some don’t feel the need for health insurance. The Massachusetts plan compels people who might not want a product to buy it anyway as the price for living in the state. While it’s their right as one of the several states, I tend not to agree with mandates of this sort.
A good resource for further discussion of the Massachusetts plan is here.
Obviously, people want to live longer and enjoy a better quality of life. Compared to our ancestors, we live much longer and in general have healthier lives because many of the diseases and ailments that plagued earlier generations have been wiped out or controlled. Going under the knife used to be a risky proposition, now millions do it simply for vanity reasons or to improve their eyesight. Drugs have moved from simply being lifesavers (like penicillin) to those devoted simply to improving one’s perceived quality of life, such as Rogaine or Viagra.
So why did President Bush and Congress push a prescription drug program (Medicare Part D) that entwines the federal government even deeper into the internal business of Big Pharma? Heaven only knows, but it’s another Gordian knot we have to figure out how to untie. The sad thing is that many people didn’t need this program expansion but will have to deal with it anyway. Instead of leaving well enough alone, or, even better, allowing the states to propose their own solutions, taxpayers are stuck with yet another entitlement.
It’s amazing how many other issues of import affect our health care system as well. Illegal immigration has forced a number of hospitals and emergency rooms in the Southwest to close as they were not being compensated for caregiving. Without tort reform, doctors practice what’s known as “defensive medicine”, ordering unneeded tests and procedures to build a case in their defense if they’re brought to court. Like the six degrees of Kevin Bacon most issues in the national limelight can touch healthcare sooner or later. Solving the issue will take a coordinated effort across many fields; paying for it is my focus here.
With the income tax system we have now (more on that in my next chapter), I think the best interim solution is to allow health savings accounts (HSA) to become easier to get and more accessible. In general, the HSA is treated like an IRA for tax purposes and is combined with a high-deductible medical insurance plan. The problem is that not all health insurance providers cater to the HSA market. Also, many states still mandate certain coverage types that may or may not apply to the individual case. Perhaps by delinking the insurance component we could get better participation. While the insurance aspect could be encouraged through financial incentive, if folks wanted to go without and participate they still may.
And just like the fiscal responsibility discussion in my last chapter, there’s an element of personal accountability that becomes part of the solution. For example, one aspect of attempting to drive down health care costs is businesses not allowing smoking on their premises. While I don’t think the nanny state should have a say in this, it’s just fine for a private entity to do so. Whereas I’m not in favor of banning transfats, common sense dictates that if you slam down two Whoppers and a king-size order of fries on a regular basis, you’ll get to be obese and that’s not a particularly healthy thing. (Welcome to my former world, I finally got a bit smarter about that. Fortunately I didn’t do a whole lot of damage to myself.)
The best way to avoid the high cost of health care, particularly the high-dollar results of cardiac treatment or combatting diabetes, is to live in a reasonably healthy manner. It’s a shame to me that kids today are already too portly for their own good because of a sedentary lifestyle. As a kid, I was out the door like a shot during the summer, out riding my bike or playing sandlot baseball. While the dregs of society have dictated a few changes to the world kids live in today, it’s not impossible for a kid to get outside and have the stink blown off him or her.
It’s those sedentary kids of today who are going to have to deal with our healthcare woes. I’d not like to see their paychecks eroded as badly as mine is now to deal with the federal government’s “one-size-fits-all” solution.
