In an editorial on health care costs, the Times describes much U.S. health care as unnecessary, ineffective, or wasteful. But it also asks “if citizens of an extremely wealthy nation like the United States want to spend more on health care and less on a third car, a new computer or a vacation home, what’s wrong with that?” There is nothing wrong with that, if they are spending their own money as individuals by their own choice. There is something wrong if they are forcing other citizens to pay more and accept less — in the case of the uninsured possibly even basic health care, to pay for it.
As it stands today, and as I’ve demonstrated in a prior post http://www.r8ny.com/blog/larry_littlefield/socialized_medicine_get_real_its_already_here.html, the three levels of government are paying, directly or (through the exclusion of employer-provided health insurance from taxable income) indirectly, for virtually all third party-funded health care right now. The government, or insurance companies, employers and the health care industry, have decided that many Americans will receive that third car. Meanwhile, others don’t get mass transit. The losers – and payers – include the working poor people who every day provide the beneficiaries with a variety of services, while paying taxes to help fund their care. The losers also include the next generation, which is increasingly classified as “self-employed” at work to be left out of government-subsidized employer-financed health care.
Under the traditional Medicare program, a potential model for a single-payer system, the patient and health care provider must either accept what the program will pay for, or forgo its assistance whatsoever. The Times, similarly, seems to assume that “we” need to decide what health care should be, and how much should be paid, for all.
The alternative is to decide, right now, that everyone will be entitled to the basic, effective, proven care the Times approves of – or an equal financial contribution to whatever health care they want, if they want to spend more themselves. And if they do spend more, it should be taxable income. There is no excuse for denying government funding for a young working person’s health care while having that person pay taxes to ensure the health and financial security of someone over 65, or a CEO avoiding taxes on a rich employer-provided plan.
Some say it would be inequitable and unjust to allow those who could afford it to pay more for a possibly better, more expensive physician, unproven but potentially life saving care, or unnecessary but potentially life enhancing care, unless everyone else could be equally entitled to expensive, unproven and unnecessary care. Let’s wait and take “baby steps” and only reduce the ranks of the uninsured until we can provide “equal” health care for everyone. Unfortunately, those making that argument purportedly on behalf of the disadvantaged and powerless are generally the privileged and powerful. What they really want is to preserve government funding, paid for by someone else, for expensive, wasteful, and unnecessary health care for themselves, by holding out the hope that everyone will receive it – something they in fact would never be willing to pay for in taxes. We are, in fact, going in the other direction, of more and more, for fewer and fewer, at public expense. And not just in health care.
If you (were one of the few people who) read my series of posts on equity and eligibility in August, you know my views on how (in particular) the Democrats have ended up using the rhetoric of equality to justify extreme injustices in their favor, with rationalizations along the way. If it were up to me, the next President would first demand that Congress pass the elimination of Medicare and Medicaid (but not the taxes required to pay for them), the elimination of employer-paid health insurance for federal employees (including members of Congress), and the counting of employer-funded health care as taxable income, effective 18 months in the future. In other words, we’ll all get something, or we’ll all get nothing, but one way the current injustice will end. Make the powerful share the fate of the working poor and younger generations equally, and I’ll bet an agreement on the moderately priced, useful, necessary care that should be provided to everyone, and the additional care that people should be allowed – but not required – to pay for on their own, could be quickly reached.
This is not just a technical issue. This is a moral issue. Let’s start with equality in government-funded or subsidized health care. Then we can decide at what level. And no, I don’t mind saying that whose who now have unlimited, wasteful, or unneccessary care should accept less or pay themselves. Including me, as I wrote here: http://www.r8ny.com/blog/larry_littlefield/the_political_economics_of_the_bump_on_my_forehead.html
(By the way, this post started out as a letter to the Times in response to its editorial. But then I realized that if I just sent a letter, it probably would not be published, but if I posted it here, at least a few people would get to see it. Just as I decided that if I took the time to show up at an MTA fare hike hearing, the MTA Board members would be gone by the time I got to say anything, so I posted my views on Room 8 instead. It just shows what the internet does — provides a forum for those whose input has been decreed to be of little value.)