Tag Archives: Healthcare

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.

Reframing Healthcare: Part II

21 Jun

In Part I, I argued Republicans could steal the heathcare debate by quitting the talk about insurance, and instead talking about the care. Specifically, Universal Healthcare. But why would any Republican, conservative or moderate, worth his salt, advocate Universal Healthcare?

Because healthcare is a significant Business and National Security issue, and historically, we have it all backward.

Let’s start with our current situation. Medicare covers 40 million people, or 14% of the population. That number will only grow as our society ages. Medicaid covers an equal amount. SCHIP grabs another 12 million children, or 4% of the population. That’s one third of our population, while barely breaking a sweat. Add in 5.5 million veterans who receive care from the VA, another 4 million that are US military and receive free government care, the millions of federal, state and local government workers, and we, as an American people, are already covering nearly 50% of the population.

But we are covering the most dependent, least productive, portion of the population.

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It is an unhelpful historical anachronism that healthcare insurance is tied to one’s employer. Because while it is certainly in the employer’s interest to have healthy workers, it is also in the nation’s interest to have a productive workforce. We are no longer a country of limited inter-state competition. We live in a flat global marketplace, where the US is daily competing with industry and business from around the world.

So while it is altruistic, moral, ethical, and commendable that our country provides care to the aged and the poor, there are still 40-50 million without health insurance. And who are they? They are disproportionately young workers. 20% of working adults do not have any healthcare, and 90 million workers (18-64) were without health insurance at some point in 2006 and 2007.  These are our recent college graduates, young entrepreneurs, and innovative leaders of tomorrow. Richard Florida, the proponent of the Creative Class and Creative Cities concept, is an advocate for workers in creative industries to be highly mobile, and to change jobs and cities frequently. It is an investment in the future of the country, and our National Security, to have these young workers, and all workers in the prime of their effectiveness and productivity, as healthy as possible, as often as possible.

Businesses themselves will be happy to shed this burden. A significant amount of time, money and resources, is wasted by companies trying to provide healthcare to their workers. If a company could shed that dead weight, and concentrate on their core mission, they will be more productive as well. In the end, GM became a healthcare company as much as a car company. Allowing America’s businesses to concentrate more on their business can only be a good thing.

Providing universal healthcare is good for this country’s National Security, and American Business. What would this universal healthcare look like?

Coming soon in Reframing Healthcare: Part III.

Reframing Health Care: Part I

19 Jun

I advocate Republicans once again be the party of ideas. Obama claims to be transformational, but in reality, his initial administration priorities seem to be refighting old fights (health insurance, Gitmo, Torture, Defense of Marriage, etc etc). R’s have an opportunity to reframe the old fights, and be the idea party again. We used to be so good at this that Dem’s wrote books on how to copy us.

So, let’s start by stealing and reframing healthcare. Currently, the Republicans are on the wrong side of the healthcare debate. To be fair, so are the Dems. Its time to start over talking about healthcare, by getting it back to healthcare.

Everyone repeat after me: we already have universal healthcare.

This gets confused because everyone seems to be arguing about health insurance. But the Frankenstein system of Medicaid, Medicare, private insurance, SCHIP, co-ops and other systems is only the way we currently pay for healthcare, not the healthcare itself. Insurance is a parasite. It contributes nothing.

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If you walk into an emergency room right now, with a broken leg, massive heart attack, or runny nose, you will receive free healthcare. If you are a child, SCHIP pays. If you are poor, Medicaid. If you are old, Medicare. If you are uninsured, the hospital takes a loss, and makes up that loss in charges to private insurance plans. This pre-existing condition of universal healthcare overwhelms any logical discussion of health insurance, because it immediately confirms that insurance is only an artificial bureaucracy placed on top of this system, whose sole purpose to create profit for private companies. Those private companies, however, are large campaign contributors, and often well liked by their customers. Thus the system contains great inertia, and is not easily changed.

Republicans need to reframe the debate by reclaiming the position as the party of competence, efficiency, and good government. They need to do this by dropping the insurance arguments, and steal the healthcare talk from the Dems. America has the best healthcare in the world, and the most inefficient. For example, our healthcare costs per capita are double Germany, Canada and France, and triple the UK and Japan. Republicans need to attack those inefficiencies, of which insurance company profit is the most obvious. Instead of fear mongering about government incompetence, lay out a conservative path for efficient and effective government to be able to act as the healthcare payer, not the healthcare provider or arbiter of care.

As I have said before, Republicans have lost the small government argument. Americans don’t want small government, and Republicans certainly can’t provide it. As George Will has said, the natural result of Reagan Republicanism is bigger government, not smaller, because it held the American people blameless for their desire for services, but blamed government for its problems. Instead of blaming the government, of which Republicans are a part, they could try to improve it. Americans want effective government, and Republicans could steal the debate by showing how government can be part of the solution.

But why should government be part of the healthcare solution at all?

Coming Soon: Part II – A Republican’s Business and National Security Case for Universal Healthcare