The newest Republican version of healthcare just passed the House and was instantly declared D.O.A. in the Senate. Which is good; it’s not enough of a fix. Then again, neither was the A.C.A. (otherwise known as Obamacare).
I’m not going to get into all the whithertos and whyfores right now; you can get that on every news channel. (Besides, I’ve already written about it a couple of times. Both are great articles; read them.) Instead, I’m going to tell you what we should have, and why we don’t already. But let’s start with…
What We Have
Democrats and Republicans alike have introduced plan after plan, each of them half measures, and none of them fully funded. The A.C.A. itself was only ever intended to be a stepping stone, and one of the major provisions in it is a tax engineered to draw the ire of every champion of alternative retirement ever. Meaning every Republican. In short, the plan was designed to fail — in a specific fashion, one politically beneficial for Democrats. Politics as usual.
(I’ll explain the evils of that tax another time — but no, it’s not just a tax on the super-rich. That’s about half propaganda.)
What We Should Have
One of my friends put it very well: “Want to fix healthcare? Remove ‘attained age 65 and’ from 42 USC 1395o Sec 1836(2).” For those of you who don’t know what that means, it’s simple: Give everyone the right to enroll in Medicare.
(Yes, I know we can’t afford that. That’s in the next section. Hold your horses.)
Anyone who looks at the whole situation will agree: If you’re sick, you ought to be able to got to a doctor, who should be able to make you better. The only things we’re arguing about are “Who pays for it and how?”, “Define ‘sick'”, and “I’m a politician, so what’s in it for me?”
Don’t get me wrong; these are all important questions that need answers — even that third one. Especially that third one, in fact, because Washington’s politicians are not altruists. If they were willing to give up things like political capital, calling each other evil, and playing who-gets-the-credit, this problem would have been fixed twenty years ago. Disagree with me; I dare you.
There are people who object to government-provided healthcare. They’ll point to Medicare and the V.A. as horribly mismanaged, perfect examples of the reason government should never be allowed anywhere near anything important. And they’re not wrong… but they’re also not right; in general, the government does a damn good job with healthcare. We only hear about the bad stuff because that’s all news ever covers, and we remember it because of something called negativity bias. NIST, NIH, the CDC, Medicare, Social Security — these things all work, and they work well. They could work better; excess regulation and legal obstacles make them all inefficient — but even as they are, they work wonders in our country.
And there’s no moral obligation for us to pay for our own healthcare directly. If there were, there’d be public outcry against the medical insurance industry for undermining the national work ethic. Retirees all across the country would be marching against the evils of Medicare and how it’s ruining their lives.
Healthcare ought to be available to everyone. Who pays for it is important, but there’s no moral or logical reason for the government not to do so. Since the simplest solution is often best — and in this case it’s far better than anything else I’ve seen — it should be our goal: Extend Medicare to cover everyone.
Why We Don’t Have It
There’s some very good reasons we can’t just do this. First and foremost, we need to answer the three questions posed above: “Who pays for it and how?”, “Define ‘sick'”, and “I’m a politician, so what’s in it for me?” But skipping over that for the moment, there’s still other obstacles.
Healthcare is ten percent of our economy, and if we screw it up we’re looking at recession, depression, and possibly a lot of dead people. It’s axiomatic that any sudden or abrupt change in a complex system always screws it up, so whatever we do we’ll want to ease into it gradually and predictably. In this case, we’ve got to apply a complete change in the way we handle healthcare in small chunks, in a way that doesn’t bankrupt doctors and hospitals and even insurance companies.
Another thing is, healthcare costs a lot, and there’s reasons for that. If we simply make it available to everyone with no restrictions, there’s actually not enough money in existence to make it happen, and there’s certainly not enough doctors. Basic and emergency care is doable, but even then we need to reduce costs, increase the supply of providers, and improve efficiency.
Did I mention that there’s not enough doctors? There’s not enough doctors. Some argue that it’s mainly a matter of efficiency; others will tell you that we just need more — but the experts agree: We don’t have enough now, and we certainly won’t have enough if we make healthcare more accessible. We need to address this while doing all the other things.
As you can see, the path between where we are and where we want to be is not simple and straightforward — and we haven’t even answered the three big questions yet.
How We Can Make It Happen
There’s good news: The above are not obstacles. These are just the conditions; they merely define the problem for us. Once we’ve got a problem fully defined, we’re most of the way to the answer. So — now we’re ready, let’s map out our solution.
We’ll start with where we want to go: universal Medicare access. As mentioned above, we ought to simplify and streamline it, but we’ll be changing things gradually; we’ll incorporate simplification in our plan. Right now, for example, it can take a year to get Medicare to pay for services; we can improve on that. This will prevent hospital bankruptcies, and when there’s too few hospitals, that’s important. Likewise, Medicare Part D beneficiaries have nobody with authority to negotiate pharmaceutical prices; that can be changed as well — and should.
We’re also going to need more doctors. Fortunately, we’ve got access to a ready source of them, one with the ability to train more fast. It’s called the Army Medical Department; there’s another one in the Navy. Curiously, military doctors aren’t allowed to go directly into private practice once they’ve left the service; for some reason, we demand additional training even for those with decades of experience. I think we can streamline that process. Meanwhile, let’s set up some army clinics around the country to fill the gaps in our healthcare system.
(Incidentally, while doing this we can also fix the V.A. It’s on the way, it’s very doable, and they’ve got a supply of skilled doctors, nurses, and hospital facilities. Lump that in there too.)
As for funding — Ya know what? Right now, we fund healthcare services, whether through insurance payments or actually giving hospitals cash. It’s just a matter of taking that money and moving into a single Federal fund. We can include states in the process or not; there’s good arguments both for and against. Right now we charge a 2.9% Medicare payroll tax; guess we’ll have to increase that — but we can also set a lower threshold, so the very poorest won’t need to pay more. Set it at a point that makes both Democrats and Republicans equally unhappy; that’s the mark of a good compromise.
Still, there won’t be enough money to give everyone full service; we’ve already covered that. On the other hand, right now Medicare doesn’t provide full coverage for everyone and everything. There’s supplemental insurance plans, and the wise retiree always has one. We’ll do the same for our new non-retired enrollees, and as part of the gradual enactment, we’ll start off by setting the benefits low and make the supplementals fill the gap. As coverage increases, we eliminate supplemental plans incrementally. And, once we reach the point where we can’t afford to improve coverage, we stop.
The Bottom Line
But that doesn’t solve everything. We have yet to answer all three big questions I raised. “Who pays for it and how?” we solved, and we also will, through gradual implementation, “define ‘sick'”, but we haven’t yet touched on the “I’m a politician, so what’s in it for me?” factor.
This is where you come in.
This article isn’t a perfect blueprint, but it’s what most people want. (You don’t have to take my word on that; there’s polls. What — you don’t think I made this all up myself, did you? I may be smart, but other people are too.) It takes into account the economic problems as well as the social factors, and it has the advantage of being entirely doable.
All that’s standing in the way is politicians — so tell them to make it happen.
Share this article — and others like it, but make sure they’re non-partisan — on social media. Send links to your senators and to your representatives — I explain how in this article — and also take the time to compose well-worded messages of your own. Tell them to get their egoes out of the way, that it’s time to fix healthcare and that they’d better do their damn jobs already or we’ll find someone that will.
Make it happen, people. You’ve got the tools; now, it’s up to you.