Wednesday, January 20, 2010

Why healthcare is so tough

extreme rightwing: Get government out of healthcare. Get government out of tax credits and tax policy in reference to healthcare. Have a free-market.

regular rightwing: Get government out of healthcare. Have tax credits and other tax incentives for people to buy their own healthcare in the way they choose. Have the government paying (in a voucher) only for the most poor and needy.

moderate: what we have today. A mixture of different models that works well for the vast majority of people for the most part with a significant minority of complaints and horror stories. In addition, millions at any one time have no coverage.

regular leftwing: Use tax credits and tax policy to find ways to cover the millions of people without health insurance. Regulate the health insurance businesses to be more consumer friendly.

extreme leftwing: have the government pay for and administer healthcare as a right to all citizens.

It is really difficult to come up with a good healthcare system that is better than the current one and is politically viable.

For me,

No to the extreme right wing.
I don't support a free-market system because it is unworkable. While it would lower the costs and improve the system for the healthy, it would be a disaster for the sick and older people. Which respectively both unfortunately and fortunately we all are destined. In addition, without the government regulating what business models were legal and equitable, there would be a lot of fraud and/or confusion that would need regulation at some point.

No to the regular right wing,
because the reality is our nation has a conscience and will not let people just blatantly suffer. Even if earlier in their life they made economic choices that lead them to where they are. So when things are good, people keep "more of their own money" and make their own decisions "better than a bureacrat", but when there's problems, what we would wind up with is more government spending and more public healthcare decisions. This would happen during the worst economic times especially and it would be worse than the status quo.
Think about the push in the early 1990's and 2000's for private accounts in Social Security. Conservatives said that they had rules that people would only be able to invest in "safe assets". They were judging this by past performance. Well, everyone has seen the disclaimers about that not being a "predictor of future earnings". And the stock market since then has crashed, and been flat to lower for now over a decade.
No matter how the partial privatization planned was crafted, at some point people would start receiving less money in their retirement. That's when the calls for bailout would begin. The same way we had to bail out the banks, and auto companies to keep the "system".

no to single payer
I say not to a single payer system because I don't want the healthcare decisions centralized. I believe in America. That means the free exchange of ideas. Maybe the current HHS secretary is great, but maybe not. Maybe we should have cancer screening at 20 and 50, or maybe 40 is right for some and not all. We shouldn't have a one size fits all policy for hundreds of millions of people. Different models and ideas should compete against each other and see what has the best price, quality, etc.

I support a center-left plan. A newliberal plan. Difficult to implement because of all the moving parts. There are the Unions who want to "deliver" healthcare to their workers in their negotiations via management. There is the vast private sector of healthcare companies. Including the big money in technology and prescription drugs. There is the vast government network including the military, medicare, and medicaid. There are the true believers of one particular approach that will demagogue any other idea. And finally you have the real lives of people who can be easily scared by either real or imagined threats.

My basic approach would be to:

guarantee health care as a right for all citizens-so that under no circumstances would someone be without the proper care because they couldn't pay.

retain the private sector and encourage as many different healthcare delivery models as possible. From fee for service, hmo's, community health clinics, hospitals, etc.

Let people choose what they like best. Never mandate anything. Use the tax code to try to hold down costs.
For example, if a reasonable plan costs on average $10,000 per family (somewhere in America(?)); give that family a $10,500 refundable tax credit for healthcare. That gives them the incentive to go get healthcare as cheap as possible and keep any money left over.

The government's main duty is to make sure what they sign up for is legitimate. To root out the waste,fraud, and abuse.

In addition, the government should make sure there is competition all throughout the U.S.
It would be good to have a public option. It could be Medicare.

Think of the Post Office:

If you want to send a package, you can use Fed Ex, UPS, DHL, a private messenger, take it there yourself, or the government option: the U.S. Postal Service.

I would make sure that the government's role was to be a last resort and not a takeover (no single payer, see above).
Taking these principles and putting it into law is a mind-boggling experiment. I conclude you have to start somewhere.

I like the current Senate and House bills. They maintain the private sector and try to build on it.

1 comment:

Libertyforall said...

Regarding healthcare. No big argument, if one at all. There should be basic healthcare provided for the government for all. Groups of individuals and/or companies should still be allowed to purchase private insurance; and if one can afford it, private physicians without any intrusive government mandates.

Regarding last night's election. I do find it interesting that Coakley won where there were paper ballots only. Apparently, Brown won all of the districts that used Diebold's touch-screen machines. As well, she conceded, from what I heard, before any vote was counted by any human being. Assuming, Brown legitimately did win. It amazes me that people would vote for a pro-corporate Republican because they were upset over the corruption on Wall Street. I actually heard people saying they voted for him because of that, on one of the Boston radio stations.

For sure. Tim Kaine needs to resign from the DNC. The gains in 2006 and 2008, including the presidency, were mainly due to Howard Dean's efforts as DNC "chair." Too, McCain and Palin would be in the White House, if not for the voters between the ages of 18 and 30. Sadly, because of the lack of publicity and the poor civics education they recieve(d), they neglect to vote in the other elections. That needs to change. The Democrats, including this president, need to stop letting the Republicans frame the argument. Offer the left-most possible legislation and compromise it toward the center. Instead, of starting off that way, and have something not even leaning center and then being propagandized as being the most liberal in history.

The young need to help this president out; and the 18 to 30 year old electorate are night center-right, that is for sure.