Fair warning. Even by my standards, this is going to be a long one.
Now that the geniuses in Washington have gone home for the holidays and a full schedule of baseball, hot dogs, apple pie and hiding from their constituents, a brief reprieve has set in that allows us to have the debate on health care we should be having, not the bail out the rich, the pharmaceutical and insurance industries debate we are having.
As I have said before, the debate in Washington is completely misdirected, and as long as it remains focused where it is, there will never be true and truly affordable health care in this country. In a nutshell, Washington is debating whether there is a right to health insurance coverage. As such, all that is being debated is how much of a profit the insurance and pharmaceutical companies are going to make, as they have absolutely no incentive to provide a single product or services, especially for a reasonable price. They are, for the most part, for profit companies that have shareholders to answer to and CEO's who want to pay for their latest toy. As such, they have no incentive whatsoever to deliver health care. Their only incentive is to make as much of a profit as they can; therefore, as long as they keep the debate focused on whether or not people are entitled to health insurance coverage, they win. You will note that none of the debate has been or is likely to be about health care itself, only how to pay for it.
I will cut off the debate right there.
THERE IS NO RIGHT TO HEALTH INSURANCE COVERAGE.
There is nothing in the Constitution or in any moral, philosophical or ethical argument that says that anyone has the right to purchase health insurance, and that any company has an obligation to sell it to you. Health insurance companies exist for one reason -- to make a profit. As such, they have the right to sell insurance to whomever they wish and charge whatever they want, as long as the market will bear it. And for the most part, the market will bear whatever it is they charge, especially when health insurance is primarily not sold across state lines, which gives a mini-monopoly to a few companies in every state. This also gives insurance companies the right to sell their product to whomever they wish, to charge ridiculously high rates to whomever they deem a risk, or to outright refuse to sell to any particular person, as in anyone they do not believe they will make a profit on. It also allows pharmaceutical companies to sell their products at whatever price they wish to charge.
That is why the costs are so high.
It has nothing to do with regulations, the cost of which is easily absorbed by any health insurance company, and churned out in increased premiums and deductibles in any event.
And this is why health insurance companies want to keep the debate focused on whether or not there is a right to health insurance coverage, rather than whether or not there is a right to health care itself. When the debate is focused on the right to health insurance, the natural tendency is to say yes, there is a right, when in fact there is not. This way, the concentration in the debate is on how we deliver health insurance to the masses, in what form, and how do we pay for it, which in turn, drives the insurance companies' profits. Notice that there is nothing in the debate about actual health care itself, which as noted above, has never been part of the debate in either Obamacare or the present nonsense proposed by Senator McConnell and his band of rich old white guys.
Why?
BECAUSE ONCE YOU FOCUS THE DEBATE ON WHETHER OR NOT THERE IS A RIGHT TO HEALTH CARE, THERE IS NO DEBATE, AND THE HEALTH INSURANCE COMPANIES LOSE.
I have said it before and I will say it again until I am blue in the face:
THERE IS NO RIGHT TO HEALTH INSURANCE COVERAGE, BUT THERE IS A BASIC CONSTITUTIONAL AND MORAL RIGHT TO HEALTH CARE, AND THAT MEANS HEALTH CARE FOR EVERYBODY.
If you start with this basic premise, the rest falls in line.
Do we need to address the opioid epidemic? You bet we do. We need treatment doctors and treatment centers. We need to educate doctors not to listen to pharmaceutical companies urging them to prescribe, prescribe, prescribe, which results in a generation of addicts. We need alternate forms of therapy for those in pain that does not cause addiction. And we need to have the system deliver it to those in need.
The same holds true for treatment of mental health.
Do we even need to debate that women are entitled to maternity care? For those who fret minute by minute about the health and welfare of a fetus, does that not mean that the mother needs to be cared for during the pregnancy and beyond? The argument that as a man I should not have to pay for maternity coverage is so ridiculous as to be beyond belief, but just for a second, I guess I should remind some of the guys out there that babies require two sexes to create, and that alone should therefore bring about at least some form of responsibility that includes caring for mother and baby.
Nobody debates whether or not we should treat a sick or injured person, even if it is treatment for opioid or alcohol abuse. And do not tell me that we do not need to provide drug and alcohol treatment because it's their own fault. If somebody tries unsuccessfully to commit suicide by slashing their wrists, I do not hear anyone saying we should not suture the wounds. When an accident victim is brought unconscious to an emergency room, even an emergency room in Beverly Hills, nobody asks or should ask if the victim is an illegal immigrant or has the means to pay. They just provide medical care, BECAUSE THAT IS THE WAY IT SHOULD BE.
So, you ask how to we pay for all this wonderful medical care and treatment that is a basic human right? After all, I have heard some, even some who are close to me and whom I admire and respect, tell me that they do not want to pay for the care of somebody else, and should not be forced to do so, especially if they are in this country illegally. While illegal immigration is a debate for another place and time, I would note that for purposes of this particular argument, I have your solution in two easy steps, after all, if the administration can put forward a comprehensive outline of a budget and tax reform in one page, I can easily solve health care in this country in two sentences.
1. Lower personal income tax rates across the board by three percent. I just made everyone, especially the really rich anti-tax guys delirious with joy.
2. Impose a national sales tax of three percent on the sale of absolutely everything, and dedicate the sales tax revenue entirely to health care. No exceptions.
There are two fun parts to this solution. First off, it is not revenue neutral, as there are plenty of people out there, rich and poor, who pay no income tax at all, some because they have no income to tax, and some because they have made a career of paying no tax, some all the way to the White House. As such, more will be collected from a three percent imposition of a national sales tax than will be lost in a three percent decrease in the income tax rates. Secondly, there is no longer any rant about paying for the health care of illegal immigrants. Now, they are paying for it themselves. After all, even illegal immigrants have to eat, have to buy clothing, and presumably have to put gas in their cars. So do the Koch brothers.
And each time a guy who has come here through a hole in the wall in the border with Mexico to try to make a better life for his family either back home or that he has snuck into the country with him buys a loaf of bread or a pair of work boots, he has paid for his health care, just as every time the Koch brothers buy an ad on television to try to convince you that liberals are plotting to destroy the country or that Hillary Clinton is the devil, or the idiot in the White House buys a new set of golf clubs, they are paying for their health care too.
Obviously, the exact amount of the decrease in income tax and corresponding imposition of a sales tax can be set by economists much more adept at figuring out what the proper number is, but you get the point.
And the overall effect?
The first thing that comes to mind is that when we pay for our own health care coverage with a dedicated national sales tax, we end up having an entity paying for health care that is not interested in making a profit; therefore, the profit built into the present health care delivery system is gone. The result is that the amount of money we are forced to pay for health insurance and for health care, for those who do not have it, goes down proportionately. We no longer need to pay for the mansions and yachts of the CEOs. Down goes the price further. With health care a public system, there is no longer any need to pay for advertising for health insurance companies. Down goes the price again. Etc.
Yes, there will be a bureaucracy created by this, and yes the health insurance industry will be harmed, but look at it this way. There will be plenty of jobs available in the public sector for underwriters and adjusters to review and pay for the goods and services through public health care delivery. Why not hire from the private insurance sector? As for the CEOs? I am sure they will manage. And the bureaucracy will be absorbed in that there is no duplicity of services. Everyone gets the same universal coverage, including mechanics, congressmen, food service workers, soldiers and health insurance CEOs. There is therefore no need to compartmentalize medical care among different sectors of society, which prevents duplication of cost at the administrative level.
Want more than a publicly administered health system will offer? Then buy a supplemental health plan from your favorite health insurance company and pay what you want for it. Go and buy whatever goods and services you want above and beyond what my proposed system offers. And pay the three percent national sales tax on the policy that goes towards paying for health care for everyone, including you.
Yes, this is overly simplified, and the details would have to be worked out, which basically means that Washington would get involved, and it would be screwed up. But the basic premise remains that health care and treatment is a basic human right, and this system, overly simplified as it may be, at least addresses that right, and not the right of an insurance or pharmaceutical company to make an obscene amount of money playing upon our health and welfare.
As such, it's a start.
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