I wrote a piece last year titled ‘Robbing Peter to Pay Paul’. Yesterday I read a thoughtful post by Kim Chandler McDonald which offered a very similar albeit somewhat different perspective on the topic of where the focus on healthcare really lies. Kim wrote on ‘meHealth’, taking the responsibility for eHealth as the only real way to create an ROI in the space http://ow.ly/5NCPN. For those who enjoy reading something by someone who knows the difference between an adverb and a potted plant and can actually write a proper sentence I encourage you to take a read.
Mine was on heCare and sheCare and it also speaks to the individual but does so without any attempt to disguise my belief that healthcare reform missed the mark http://ow.ly/5NDet. Kim wrote asking what if anything has changed in the period since I penned my piece. For those who may have missed it, and to borrow from FDR, my premise was that the only thing to fear about healthcare reform was reform itself.
For all the talking that healthcare reform created, the silence on the topic has risen to a new crescendo. The only thing that has changed concerning reform is that the silence has grown louder.
Why has reform missed the mark and what can be done about it? Permit me a moment to illustrate. I would ask that all the altruists reading this post take one step forward—wait a minute Sparky, where are you going? The reform package efforted (simple past tense and past participle of effort) to be all things to all people, especially to those who have been disenfranchised under the current system.
While the goal is laudable, it did not pass the test of being both necessary and sufficient. Its insufficiency is hampered by the fact that when we are ill altruism ends at our individual front doors. It goes back to the notion of robbing Peter to pay Paul. Do unto others, but do not undo unto me.
Most observers believe there is some dollar amount that contains the total spend available for healthcare and that to increase services to those less fortunate—the theyCare populous—means paying for it by removing services from those who presently have healthcare, the heCare and sheCare taxpayers. And, it is those same people, the heCares and sheCares, whose support of reform has fallen silent.
While a rising tide may indeed lift all boats, it also drowns those tethered to the pier.
Louisiana Senator Landreiu was interviewed on NPR and was asked why she does not favor a public option. Finding it to be the most reasoned argument on either side of the discussion, I felt it worth sharing.
She began by using an analogy she learned from Senator Lieberman. Assume that the roofing companies in America were so expensive that twenty percent of homeowners could afford to put a roof on their house. What would the government do? Would they set up their own roofing firm and offer roofs at lower prices? Of course not. It would regulate the roofing companies to bring about lower and more competitive prices.
Landreiu also stated that the government hasn’t done very well managing its other two public options, Medicaid and Medicare, so why trust them with running a third.
Who Will Lead
Dirk Stanley posted this link from the NY Times about the death of the public option.
Now, we can either bemoan this or we can try to lead. Here’s my take on how to strat the discussion.
To insure the uninsured we don’t need a public option. When poor people were denied access to banking and credit, the government did not create a public bank. It regulated the banking organizations and made it illegal for them to redline the poor.
Can we not regulate the payors in the same fashion, requiring them to insure the uninsured? Were not Medicaid and Medicare created in part because payors relined the elderly?
The government requires everyone to have automobile insurance, placing the onus on the individual. Why not flip it? If the goal of reform is to get people access to healthcare, which under the existing business model implies insurance, require the payors to provide it. The government can subsidize the payors, or pay it in full, and it can do so without adding to the bureaucracy of further entitlements via a public option.
To me, two other ideas make much more sense, one of which I’ve previously offered. Large groups of people are without insurance or are under insured. The government wants them to have access to medical care. As stated above, the government already created two agencies to address this problem, Medicaid and Medicare. Why create a third? Can’t those people be added to the two existing agencies?
The other idea may be the same, but if implemented differently, could streamline the processes and the cost. Make the cost of the coverage to those groups an offset against whatever tax they would owe. If it costs ten thousand dollar to insure a family of five, offset it against their income tax obligation. Net net its’ the same cost whether you collect it and refund it or simply don’t collect it. Give these families so sort of smart healthcare debit card, the government owns the account, and all healthcare providers can accept it for payment.
Sure, there is unlimited fraud potential, just like there is under any other option.