By Isaac Yetiv, Ph.D
LA JOLLA, California — In my previous article in the series, I advised that the Federal government limits its functions to the powers enumerated in the Constitution in accordance with the tenth amendment. Health care is the example par excellence of what the federal government should not touch with a ten-foot pole. It is huge; it touches more than 300 million individuala; it is very expensive (1.6 trillions over 10 years.) And the Fed is notoriously inefficient and wasteful : the post-office, Amtrac, medicare, medicaid, social security , all bankrupt. Look also at other nations’ experiments , like the United Kingdom and Canada, both democracies in good standing.
In both countries, attempts by the government to make changes met with strong opposition , even riots in the UK, because of
“acquired advantages” that, once given, it is practically impossible to take back.
As I wrote before, Healthcare is a “third-rail issue.” Since I am not a politician, and fiercely politically independent, I will touch it. I will take off my ideological hat and don my bonnet of pragmatism and common sense, keeping in mind “the greatest good for the greatest number of people.” I hope you do the same.
What does health reform mean to you?
This is the title of a brochure published by NCPA (National Center for Policy Analysis. ( I suggest everybody gets a copy: ncpa.org or call 972-386-6272.) This is a treasure of information on the 2,300 pages law that Congressmen didn’t read but still voted on. I am quoting from it, just the highlights:
. You will be required by law to have health insurance, and attach proof of it to your tax return.
. If you don’t, you pay a fine up to $ 695 ( $2,085 per family.) If your employer doesn’t offer insurance, he will be fined $2,000 per employee per year. This is only one seventh of the cost to the employers to insure your family. What do you think they will do?
According to Medicare actuaries, 14 million employees will lose their employer plan, and within 3 years, more than 100 million people
will be forced into a plan more costly and more regulated. Cost: According to CBO (Congressional Budget Office), coverage in 2016 will average about $ 5,800 for an individual (15,200 for a family of four.) More than half the cost of the reform will be paid for by reducing Medicare expenses by 500 billion. There will be new taxes on drugs and medical devices such as wheelchairs, crutches, pacemakers etc…and on many other items like selling your home.
.Insurance premiums will be raised to compensate for those with preexisting conditions and those who are subsidized.
. Employers who decide to offer health insurance may have to reduce wages and other benefits, and the extra burden could cost as many as 700,000 jobs by 2019.
. The enforcer of the reform is the IRS (!) that will have to hire 16,000 more agents (in the beginning) and train and pay salaries and benefits that will cost many more billions of dollars. And this is an unhealthy and scaring intrusion that smacks of a police state.
. Medicare actuaries predict that you may not be able to see a doctor when you need help.
Those who are on Medicare Advantage (I am one of them) will lose $1,267 in 2014 resulting in lower benefits and higher premiums. And one in two Medicare Advantage members (7.4 million) will lose their plan entirely (I don’t understand why–I.Y.)
Today polls show about 60% against the Healthcare Law. With this chilling objective analysis, the more people know, the more they dislike it, not only its genesis (arm-twisting, bribes, threats, and misleading promises about “public option,” abortion, artificial manipulation of cost, waivers and exemptions to certain categories of people etc.)) but its end-result as detailed above.
Why are they doing it? Why this insistence on Obamacare despite its unpopularity? Of course there are good things in it, but they could introduce them as amendments to the status quo without revolutionizing the whole system (see below.)
The real reason is ideology the belief that the government can do better by coercion than free market and competition. So they
ostensibly appear as the defenders of the poor and the “uninsured” , which is false in itself because the poor are already covered by Medicaid, and the uninsured must , by law, be treated by the hospitals.
How do they explain it? They invoke inefficiency, greed of the insurance and pharmaceutical companies, unfairness, all true to a certain extent, but that can be easily remedied and , rather than owning one sixth of the national economy, the government still retains the power and responsibility to oversee, regulate, order safety (like OSHA, for example), and protect the consumer.
The government,deplorably, resorted to dishonest manipulation of the facts. For example, the number of “uninsured.”
How many times we heard about “50 million uninsured Americans, 47 million, 40, 34 and horrible demagoguery to arouse “compassion?” Pure demagoguery.The truth is very different. These numbers, whatever they are, need to be reduced by:
. 12 to 15 millions of illegal aliens. No country provides free health care to citizens of other countries. (I believe they, too, should be covered –see below.)
. about 15 million people , aged 18 to 35, who voluntarily refuse to buy insurance, feeling they are invincible.
. a few million of children under the age of 18 who are covered by SCHIP (State Children Health Insurance Program) mandated in every state.
. a good number of people, lazy or ignorant, who never signed up for Medicaid or any other program for which they are eligible.
Experts agree that the REAL number of “uninsured” is about 5 million or about 3 % of the whole. A great country can easily take care
of them without a revolution, which will be needed when they tackle the “entitlements.” (see below.)
What to do?
The situation as it appears today is a big mess: To date, 27 states have sued the federal government, most of them about the “mandate” for everyone to buy insurance which they consider unconstitutional ; this will certainly end up in the Supreme Court in a year or two.
And, politically, the House of Representatives has repealed the healthcare law, thus putting the 25 Democrat senators who are up for re-election in 2012 in an untenable position to defend the law that is getting more unpopular every day, and lose the election.
Therefore, now is not the time to revolutionize the healthcare industry that encompasses one sixth of the national economy.
What to do In the short run?
1) Keep things as they are for those who have insurance ,whether through their employers or any other way, and are satisfied with it
(polls show 86 to 90 %.) and
2) Help those who are not insured , and who do not qualify for existing programs. Just help pay their premium on a sliding scale according to their financial ability. The helping entity should be the state, not the federal government.
3) Those who are able to buy insurance and refuse to do so shall be warned that, if they face a medical situation, they will have to pay
the bill, like any other debt, with the same legal sanctions.
4) The illegal immigrants , who are still citizens of another country, shall be incorporated in the system but not have a free ride. Their employers , like all employers, should be required by law to deduct from their wages the appropriate percentage.
5) A tort reform should be enacted on a bipartisan basis because it is good for all. True, the trial lawyers are big donors for the Democrats but the public interest comes first. It is well known that, because of the fear of being sued, physicians and hospitals practice “defensive medicine” which almost double the cost.Many doctors ceased to accept “risky” cases or quit the profession altogether.
6) Employers, individuals, and even the state itself, should be allowed to buy insurance from out-of-state. They should be able to shop around for the best and the cheapest. Only a free competitive market will break the grip , and eliminate the accusation of greed, of the insurance companies. This will also increase the pools and allow for portability and coverage of those with preexisting conditions.
A way should be found to make the consumer, the patient, responsible and selective in his choices instead of the third party payer.
In the long run:
These recommendations , good for all, can be enacted in a week, but they are only temporary. The Healthcare problem is tightly tied with other “third -rail issues” ( medicare, medicaid, social security, welfare, tax code, etc) which, as I wrote before, only non-partisan commissions could resolve , thus bailing out the politicians of both parties from responsibility and fear of retribution from the electorate.
The non-partisan experts will have to breach the “sanctity and untouchability” of these acquired advantages which we call “entitlements.”
Failure to do so will bankrupt the country. The federal government ,with a national debt of 14.3 trillions at last count, and many states, including California by far the worst, would have been belly-up long ago if they were private enterprises.
Let us not delude ourselves. If the “entitlements” continue their present course, with all the attendant inefficiencies, mismanagement, waste, fraud, and discriminatory practices, and if we continue to borrow and spend, they and the interest on the national debt will eat up the whole national pie of revenues. Nothing will be left for anything else. If that occurs, the only choice will be to tax at 70-80 % or print trillions of new money, an inflationary act of despair that will dangerously reduce the value of the dollar, or both.
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Yetiv is a freelance writer based in La Jolla