Half-Assed Healthcare, Part 1 (of Several, Over Future Weeks). This country has really screwed up healthcare. If you have all the money in the world, and live almost anywhere in the world, you might find U.S. medicine top-notch. And so it is, for those who can afford it. For the rest of us, it is a disaster. It costs ridiculous amounts, and that ridiculous cost goes higher every year at three times the rate of inflation in the economy overall — including healthcare. Were we to exclude healthcare from the general rate of inflation, the rate of inflation in healthcare would be even higher.
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I'll try to divide this enormously complicated topic into small subtopics, like pieces of a jigsaw puzzle except that each piece by itself will make sense.
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Let us first address the fact that our elected representatives are entirely out of their depth when it comes to solving the healthcare mess. Hillary Clinton put together a plan for universal coverage that was universally criticized / condemned as overcomplicated. The Bush Administration actually enacted a prescription drug plan that could not be less complicated than Hillary's universal-healthcare plan. Whereas Republicans were extremely vocal about how 'unworkable' Hillary's plan was, they actually put in place a program that is so insane that the people it is meant to serve are hugely disserved instead. And now the Republicans want to punish people who cannot wade thru the masses of data they have to evaluate, in their old age (not to say "dotage", tho that term assuredly does properly apply to some), by fining them if they don't enroll by a certain date in May. Why?
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Why should anyone have to enroll in an ongoing program by a specific date or be punished? Why are Democrats effectively silent about this outrage? Are they merely so feckless that they have in fact protested but nobody has heard of it? Or have they consigned themselves to failure in opposing a Republican steamroller on prescription drugs, so consented to have old people victimized by heavy-handed bureaucrats in the service of private insurance companies?
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The second bit of governmental madness is the various states' utterly inadequate, insane, and counterproductive efforts to insure their own citizens.
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One of the challenges I have had in trying to persuade Canadians to join the Union is their worry that they would lose universal health coverage. I tell them that any state, or group of states, can enact its own universal program any time it likes, because states have that kind of power. If no one state wants to do that, it can join with other states to create a super-"group" with massive bargaining power to control costs. Small states could join together in a consortium like the Powerball or Mega Millions multistate lotteries.
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But the programs that existing states have actually come up with fall miserably short of persuading Canadians that they can replace the Canadian national program with a state-by-state or Canadian regional program within the context of a united North America.
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My younger sister, who lives in Long Beach, California, told me by fone last nite that the California fallback program for residents who are 'declined' by private health insurers will provide coverage for anyone — for $900 a month, nearly twice the going rate for a private insurer! How can that possibly be? How can a state with 35 million people not have the world's largest 'group insurance' program, at the lowest cost?
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On the opposite side of the continent, Massachusetts just enacted a program to compel its citizens to take private health insurance. But no government can compel its citizens to spend their money on any type of private company simply as a condition of living in its jurisdiction. Tho the comparison is made to laws relating to cars — and remember that driving is not a right, whereas living in a given state is a right — and specifically to laws that require people to have liability insurance as a condition of owning a car, the comparison is absurd. Note that drivers who do not own a car are not required to have liability insurance for driving. So the comparison to driving is, from the outset, utterly void.
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Pedestrians are not required to have automotive liability insurance, just because they could conceivably cause a traffic accident if a car has to swerve to avoid them. Renters could not be required to have renters insurance. Vacationers could not required to have vacation insurance, nor purchasers of various appliances be required to purchase extended warranties. These are the kinds of comparison that should actually be made.
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More, how can government possibly require private persons to spend their money in ways they do not personally choose, to give over their hard-earned cash to private businesses against their will? If this is permitted to stand, any government could require its residents to spend a certain amount of money in any area of the state economy its legislators desired. Why not mandate that people spend a certain amount in fast-food restaurants, fine-dining restaurants, motels or hotels, mountain resorts, bed & breakfasts, any area of the economy the legislators feel people need to support?
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The rationale behind Massachusetts' insistence that people have private health insurance, that if they fall seriously ill or have an accident, other people will have to pick up the costs of their treatment, is at once both false and irrelevant, and could be applied to other areas of the economy as well. If financial damage to others is the criterion by which government is empowered to decide that citizens must spend money they don't want to spend on businesses they don't want to patronize, then anything is possible. Because any business failure costs a state in unemployment payouts, loss of sales-tax collections, loss of property-tax payments, and on and on. So to keep any part of the economy 'healthy', any state could require its residents to spend their money as the state demands. That is plainly and absolutely unconstitutional.
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The state (here meaning state of the Union or government in general) has no right to tell people how they must live and how they must spend their own money. The Fifth Amendment to the federal Constitution says plainly:

nor shall private property be taken for public use, without just compensation.

A person's money is his property. Protecting government from the medical costs of uninsured residents/visitors is a "public use". And what about visitors? should Massachusetts impose an insurance requirement upon visitors to Massachusetts? how about people just passing thru Massachusetts on public roads? couldn't they have accidents that would require uncompensated medical treatment?
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Massachusetts offers no "just compensation" for its mandate that private persons spend their money on private insurance. If a person is healthy for 20 years and makes no demand upon the health insurance he is required to purchase, he could pay hundreds of thousands of dollars for absolutely nothing!
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In the past year I have spent over $5,500 on health insurance and been to the doctor exactly once. That's outrageous. My monthly cost has just gone up by $120 a month, to $575 each month! I have had knee surgeries in the past, so have been told that I have to have continuous health insurance in order to have coverage for a "pre-existing condition".
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Massachusetts wants to require healthy residents to spend a minimum of about $325 a month on health insurance from private insurers. Impossible. Bay Staters need to take the Republican governor and his Democratic lackeys in the state legislature to court to establish that government cannot properly nor legally compel residents to spend their money in government-selected industries, or face punishment by the state.
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What government can properly do is institute universal healthcare by creating one enormous "group" plan, self-insured or backed by a consortium of private insurers, that will use its enormous size and, thus, bargaining power, to drive down the insane costs of healthcare. It can fund universal healthcare thru taxes, because then it is a government charge for a government service. But it cannot use government compulsion to benefit private corporations at the personal expense of ordinary citizens who don't want to buy those corporation's products or services. End of discussion.
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Well, that's the end of this particular discussion. There's a lot more to discuss about how we can fix our healthcare mess. I'll address other aspects of the fix over time. Stay tuned.
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(The current U.S. military death toll in Iraq, according to the website "Iraq Coalition Casualties", is 2,389.)
- posted by L. Craig Schoonmaker @ 2:07 AM