Reframing Healthcare: Part III

26 Jun

In Part I, I talked about reframing healthcare insurance, and by admitting we already have Universal Healthcare, shift the focus to the healthcare itself. In Part II, I gave a Republican argument for Universal Healthcare, based upon National Security and Business needs.

But what should this Universal Healthcare look like?

A Conservative definition of the role of government is that it should exist to provide services that an individual can not do on their own. National defense, the printing of money, and paving of roads traditionally fall in this catagory. Healthcare should as well. Universal Healthcare needs to be seen a social service. That is, a service provided to members of the community, for the overall good of the community, and paid for by the community through taxes. While police protection and garbage collection count as social services, the model for Universal Healthcare is public schools.

Did I already lose you? “But we have failing public schools”, you say. “Why would we want a healthcare system as bad as our schools. Isn’t this proof Universal Healthcare is a bad idea?”

Public Schools are the right model for healthcare for a number of reasons.

1) Public Schools are funded through a mix of funding: local, state and federal. We do this because not only does the country as a whole recognizes the need for public schools (thus federal funding), we also believe in local control of schools. Healthcare should be the same way. It should be funded with large block grants from the feds for a minimum amount of services (Medicare, plus the new Universal Funding), but then also funded by the state (Medicaid), and controlled and funded by local governments. Healthcare should be locally controlled because healthcare needs vary by community. Buffalo has a higher rate of heart disease than the national average. Local control would allow our healthcare system to better reflect this.

2) The existence of Public Schools does not preclude the existence of Private Schools, Charter Schools, home schooling, and other options. There has been a lot of fear-mongering that Public Healthcare would crowd out Private Healthcare. Why? Private Schools shouldn’t be able to “compete” with Public Schools under this argument. Why would I pay for schooling when my kids could get it for free? Well, millions do, because they like a Private system better. The Catholic Health System can still exist, because it has a clientele.

3) Public schools have physical infrastructure distinct from Private or Charter schools. The same with hospitals. I believe hospitals, clinics, and other healthcare facilities would have to “choose” to become Public Hospitals, or Private non-profit or for-profit hospitals. The government could also choose to fund Charter Hospitals. How these hospitals would provide emergency services and reimburse each other would have to be worked out. But a model already exists in the VA Healthcare system.

4) We may argue about how to fix public schools, but we don’t argue about their right to exist. We should view Universal Healthcare the same way.

But how to pay for it?

In 2008, the average cost of healthcare for a family of four was $12,680. That works out to a $1 trillion a year, roughly, for the country as a whole, and is paid for by a mix of employer contributions and premiums by individuals. Not to mention the $100 billion we spent as a country to provide healthcare to those without insurance. I am not advocating that the government raise $1.1 trillion in taxes next year. But efficiencies won’t be realized immediately, and it will look costly at first.

Our country raises money three main ways: property taxes, income taxes, and consumption taxes. Property taxes are too linked to housing bubbles, as currently being experienced in Florida and other states. Income taxes are already a mess. A national VAT would be initially unpopular, but is the fairest way to keep the tax progressive. One benefit of Universal healthcare is that it may finally spark a national conversation on tax reform. And any sale of this plan to the American people who have to show how they would have an average of $1000 extra in their paycheck every month.

Is this a bridge too far? Republicans went from the party of “Abolish the Department of Education” to “No Child Left Behind” in one year. We can move to the right side of the healthcare debate too.

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