Proponents of comprehensive national health care fall short of the mark when it comes to proposing an equitable plan to pay for it. Naturally, the first thing we can do about making sure people can afford health care is to reduce the entire price structure, focusing medicine back on care and less on profit. And, just as importantly, we must aggressively prosecute those individuals or companies that perpetuate fraudulent billing claims, enriching themselves while robbing the system of needed finances. These measures will help decrease the costs of health care considerably, as do many of my suggestions in the preceding three essays. (Strangely, these are not areas that are focused on; instead regulation explores areas to cut care rather than rein in costs.) But the fact remains that health care is still going to cost money, and it should be a shared responsibility between the general public and the health care industrial complex. Citizens must shoulder the costs for their own well-being and medical care, but the industries that depend on sickness to survive should also establish a public trust to help defray the costs of long term or catastrophic illness. At the same time, medical costs must be kept within financial reach for all legal citizens, regardless of their actual income level.
First, we need to have a more clear vision of what a reasonably healthy person’s annual medical costs may be. Simply a random ordinary citizen, with one medical physical a year, two dental cleanings a year, and one vision check a year, even at $200 per visit, the annual bill is around $800. Let’s throw in a few random blood tests, two cavity fillings, a pair of glasses and a pair of contacts- roughly $700. Finally, we’ll add various medicines, both over-the-counter and prescription drugs at $200. Annual total is $1700, or $142 per month. Now honestly, most people go years without cavities or blood tests, or even eye doctor visits and physicals. Their annual costs could be much lower, assuming that no catastrophes occur. (These dollar figures are estimates and for illustrative purposes only. Actual costs may in fact be much higher due to rampant greed within and without the industry.)
The simplest solution is a national health tax; the collected funds being deposited into a publicly administered and managed account, and disbursed according to well defined guidelines. The tax itself could be collected in several ways, to better ensure that all citizens are contributing to the fund according to their financial ability. To start, every legally employed citizen would deposit in to the system a percentage of their earnings, deducted from their regular paychecks, pre-tax. The formula for determining the percentage each person pays could be derived in several ways: basing it on an average annual medical cost of a healthy person at their age; by dividing the total population by the total national health care bill to arrive at a per capita figure; using the percentages from either of the former equations and developing a sliding percentage scale further based on actual income. And we’d need to figure in the costs for children and retiree coverage, since they are not in the workforce but will still need care. Any formula will be imperfect in the goal of attaining universally affordable health care, simply because the word “affordable” is such a relative term. But some such formula would need to be agreed upon that best reflected equitable terms for the largest number of citizens.
For those who can, but for whatever reasons do not (stay-at-home parent comes to mind), have regular employment, the health tax could be collected from the primary worker’s pay or through an annual tax payment, similar to today’s income tax. Or, more creatively, these citizens can recoup their health costs to the system by working in the system as orderlies and assistants for a fair hourly wage, the earnings of course being returned to the tax fund to cover their annual contribution rate. Such a barter arrangement should be limited to those not in the established workforce, to ensure a continued influx of actual cash from those who are, but would further reduce the overall operational costs of health care in general.
In return for paying the health tax, citizens would enjoy free office visits and aid from their neighborhood clinics, discussed in the previous essay, “The Doctor Will Be With You Shortly.” Vaccinations, minor stitching, first aid, and minor aches and pains would be treated as needed and would require no co-pays or material costs. Also included at no cost to patients would be basic pre-natal visits, bi-annual dental exams and cleanings, and an annual vision test if needed. Provided the medical matter could be resolved within the neighborhood clinic setting, citizens could help control costs for themselves and the system overall by learning what requires a doctor’s attention and what does not. The neighborhood clinic is the first barrier in the war to controlling costs, which it does by both handling minor, non-emergencies and by educating patients to recognize real medical problems from over-hyped non-issues. Also covered by the national tax would be annual medical screenings at your primary personal physician.
Patient costs would move beyond the national tax and into the fee-tax arena once their sickness went beyond the scope of the neighborhood clinic. Any visit to a personal primary physician, except for an annual preventive screening, would require a co-pay and a materials fee, again based on a formulaic percentage of some sort, but with a maximum ceiling and a consistent, reality based materials cost list. For those citizens unable to manage these costs, a no-low income safety program paid for in part by the public trust fund established by the health industry would cover these costs.
Finally, catastrophic medical situations could be paid for through a higher co-pay, based on procedure rather than on a standard admission fee, and adjusted according to an equitable formula. In addition to the co-pay, the patient would be responsible to pay up to 50% of the actual costs of the medical procedure, up to a maximum out-of-pocket expense, but would be allowed to negotiate a no-interest, long-term, no penalty, flex pay installment agreement. Such an agreement could not be used to foreclose on any citizen’s property or garnish of their wages too severely, provided the citizen maintained communications with the fund administrator. At the same time, citizens trying to evade their medical bills with malicious intent should be brought to justice and forced to repay, this time at the terms of the courts.
With regards to medications, cost control measures could be applied so that common remedies are readily affordable while designer drugs are much more expensive. Medical necessities like crutches, wheelchairs, and other reusable items could be rented for low daily or weekly fees, paid entirely by the patient, with the money being recycled into the system to perpetuate itself indefinitely.
The national health tax would pay the actual costs of maintaining the nations health system, from buildings and administration, to doctor’s fees and diagnostic and treatment costs, as well as to continue ongoing discovery and cures. But it would not pay for any type of elective surgery; doctor assisted suicide, or non-medically necessary abortions. Patients succumbing to the vanity medicines like elective plastic surgery or enhancement or magic libido potions should be required to foot the entire bill for these procedures, and at elevated costs and perhaps even be subjected to a vanity tax as well.. Provided that the procedure is not a necessary element of some greater illness or accident, elective surgeries like these use up valuable medical resources and should really belong in a private field of medicine, completely removed from a national care plan. The same is
true for doctor-assisted suicide, since the issue raises serious questions for people of differing faith. While the option should be available for those who want it, they should not rely on commingled tax dollars to pay for the costs. And really, how much can a few pills really cost? Finally, non-necessary abortions should be paid for by the patient, unless in case of medical necessary or verifiable rape or incest.
Contributions by the health care industry to a public trust fund would help defray costs incurred by expensive, life saving operations, long term-care for patients, and no-low income patients. In return for their contributions to the fund, they would receive generous tax breaks that could be reinfused into their R & D programs. They could receive specific supply contracts to ensure a steady flow of business. And all businesses, save for the insurance industry, would benefit by not having to pay health costs for employees and their families, something only fair if the National Whole Life Retirement Plan were to be adopted, as businesses would be solely responsible for funding the basic level of the nation’s retirement program.
The ideas presented in this four part discussion on medical care are a starting point, not necessarily a final answer. But taken together, they represent an effort to move outside the current environment of greed and profit above all else. Medical care is something we all need at some point in our lives. We should never expect a free ride, but we should also never have to fear that the costs of getting care are out of reach.
This entry was posted on Tuesday, May 31st, 2005 at 6:57 am and is filed under Government, Health, Life, Politics, Reform, Social Programs, taxes.
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May 31st, 2005 at 11:17 pm
Ken, another fine installment. I like this question: “And really, how much can a few pills really cost?” Pennies or not even if you think about it. Much of the actual pill is comprised of dormant/non-active ingredients. Sure the research and development costs are tremendous, but the reprehensible practice of supply and demand are at play when the pharmaceutical cartels figure out how much to charge you for your viagra/lipitor/etc…and for the really good drugs, the kind that can save your life, they really have you by the nuts on that one. Got to pay. The other choice is not good.
Incidentially, the one sticking point, although I think this would be covered by your national tax suggestion, could revolve around indigent individuals (e.g. the homeless vets we so commonly come into contact with while at a stop light as they pettition us for change or some food). Many folks use emergency rooms for their primary care facilities. No home, no job, no health care coverage = no primary care physician, no regular visits (e.g. wellness care, to keep a person healthy). That is a larger issue, but certainly tied to the cost of health care for all Americans.
June 1st, 2005 at 12:49 am
I’m not so sure the barter arrangement would work. I once lived in a state that tried something like this to collect child support. People would agree to the arrangement in the court room but they wouldn’t show up to do the work. A warrent would be issued, they would serve their time in jail at the tax payers expense, when they were released they still didn’t do the work.
God Bless America, God Save The Republic
God Bless America, God Save The Republic.
June 1st, 2005 at 7:02 am
Hey now I thought it was a good idea. Hmmm maybe I should think some more huh?
June 1st, 2005 at 6:08 pm
It’s worth looking at how health plans operate in various European countries. In the US, we pay more per capita than in many countries which offer universal coverage, but our life expectency is actually lower — and we have 40,000,000 people without coverage. In this sense we are already paying a tax that is way too high.
June 1st, 2005 at 8:44 pm
We thought my wife would have to go see the Doctor today, we even made an appointment. Then she decided she would be alright. She had to call back and cancel her appointment or she would be charged for an office call. Would that be considered greed?
God Bless America, God Save The Republic.
June 2nd, 2005 at 9:26 pm
I’m unsure how this would work for Seniors, who encounter greater medical issues as they age, Their pharmaceutical requirements also increase. I have 3 elderly parents/in-laws that my husband and I are taking the point position on, and their needs are completely different from ours or our kids. Higher financial responsibility for treatment on fixed incomes would be a tough sell.
June 2nd, 2005 at 10:19 pm
Ken,
Some of your ideas here are interesting, but a national health tax was attempted with “Hillary care” that was laughed out of congress. It is also already a disaster happening in Canada where people wait sometimes for months before seeing a doctor that will treat them. Many end up coming into the U.S. to get the required medical attention they don’t get up there.
Even in Europe now, their tax structured socialism is falling apart as unemployment soars and healthcare rises, all of which is now in crises mode now due to the rejection of the over regulated Constitution.
The lessons of the recent EU debacle tells us that the very LAST thing we need in the U.S. are more government sponsored programs paid for by increased taxes! Social Security is another lesson we are learning from because of the harm done by overtaxation that does not deliver on its promises due to government’s overblown pig barrel spending in taking from pocket to put into another to cover their asses.
Also, I don’t want the government telling me who to see, or if I can live or die, as would be the eventual outcome of this type of (yet another) bureaucratic nightmare.
June 3rd, 2005 at 6:10 am
(responses)
Windspike- I think the fund created by the medical industry profits could also help pay the costs of care for the indigent population and provide them the same access to the neighborhood clinics, which would have no “cover charge” so to speak.
The veterans issue is another post altogether, which I will address.
David- Well, sometimes ones health is more important than ones kids, at least to a selfish parent. So maybe the results would be better with health care as the pay-off. Besides, many people without healt insurance aren’t simply lazy or shiftless or unemployed, but are self-employed, or artisans, or home-makers, all with time to do a little work and all needing good health.
As for the office visit, yes, that is a classic example of greed. Courtesy demands a call for cancellation, but to penalize rudeness? A classic example of the needlessly rising costs of health care. They would probably bill your insurance for a whole visit if you didn’t cancel too!
Angel- Your ephemeral comment leaves me as confused as you appear to be. But thanks for dropping by.
Overseas Will- Which is what prompted me to try and come up with alternative solutions. I think opposition to any kind of universal care stems not from a desire to keep people from doctors and good health so much as a growing fear of government ineptitude. But why do we seem to forget that WE are the government, if only we’d resume control of the wheel. Thanks for the comment.
Jet- Welcome back. I mentioned the need to figure in costs for children and seniors from the employee tax. Sure, this is akin to today’s retirement plan and screams for attacks of “wealth redistribution” but so what? All taxes are wealth distribution so the measure shouldn’t be who’s paying more but rather is the money spent wisely? If it is efficient, the taxes needed would probably be lower than today.
So seniors would be covered in that sense, as well as with the neighborhood clinics and hospital care. As for the costs of frequent treatment due to old age and bodily deterioration, we could institute both a yearly and lifetime out-of-pocket expense cap that could work off of a sliding scale, with the industrial fund covering the remainder.
Ottman- I don’t give government any power of choice of your personal doctor, only provide you with more options at lower costs, at least ideally.
As I mentioned in an earlier response, we can’t keep denying that the government is US and WE have the responsibility and the power to make sure its actions are accountable. If we only exercise them with reason and demand honesty from our elected leaders.
Minimal management would be optimal when coupled with the reforms presented in the first two essays of this series, so inflated government isn’t really the goal. More effective and efficient government, controlled by US according to our common good, is the goal.
If the system is as bad as it is, would it hurt to try something new?
June 3rd, 2005 at 12:20 pm
A very well written article, thanks Ken. Coming from England, I do have to say I disagree though. Since we live with a system that is so similar to the one you describe I think I can see it’s true effects. Waiting lists are unnessesarily long, there is no choice, and the health workers are rediculously underpaid, hence the shortage. Private health care works, it is efficient, and it provides choice. What the US (and the UK) needs is a truely private health care system, not the system in place now with back door regulation through the AMA. To answer the origonal point of the article though, free at the point of use healthcare does not mean publicly funded. Insurance provides the “free at the point of use” part better than taxation ever has.
June 3rd, 2005 at 9:43 pm
Ken,
Thanks for your response. I think trying something else is a good idea within reason, but we have to be realistic about it and not deny that those in government tend to protect their own, so you can never really rid it of corruption or dishonesty, unless WE (good point), take control of the purse strings as individuals instead of letting them have it.
Trusting elected officials is a risk we take. Some are good and others bad, but most play by the same set of rules to keep themselves in power.
It is those who grab for power who get corrupt and are usually found out, but after the fact. I think we need term limits on congressmen and women that will help to lessen the corruption by making it easier to replace them.
June 4th, 2005 at 8:03 am
(responses)
Dan- It’s always nice to have a well constructed opposing opinion to really make one think things through a little deeper. While similar in outward structure, my plan is not consciously based on another specific model or purposely created as an amalgam of other systems. My plan does offer chioce for the patients, but includes some personal responsibility for determining the level of care actually necessary. Ideally this could decrease waiting lists, not increase them. Underpaid or overworked? There is a difference, even though one can cause the other. A better management of human assets is definitely inorder, again to which I have tried to supply some ideas. Private health care does work, obviously, but so does public care. If the only determining factor is whether something works, we’d never bother to fix a leaky faucet.
I don’t hold your esteem for the insurance, but maybe yours is a bit different over there. Here, insurance is mandatory for many things, and expensive, and usually has many exclusions to its coverage. Further, if you make a claim, they increase your rates, fight paying out, and sometimes cancel you and blackball you or your property. A public tax offers the same benefits as an insurance policy, but with the possible benefits of being controlled by public hands who would be less likely to set precedents that could one day harm themselves. Thanks for your comments. And maybe someday, you’ll find something to agree with me on.
Ottman- The rules that the politicians play by are the rules we let them play by by our own sheer apathy. WE are responsible. They can be really good at collecting money, but our own lack of attentiveness allows their greedier nature to take over and trouble begins to brew.
Politicians are not elected to protect their own, but to protect and serve the citizenry. It is up to us to make sure it is so, either through term limits or more involvement or other ideas. Eventually I’ll make some comments on these things too, but our conversation has, in part, led to my next post.
March 16th, 2006 at 10:31 am
Don;t believe these neocons, Ken. Universal Single-Payer Medicare for All will save money in the short and the long term! Can you imagine if everybody with a drug or alcohol problem or serious mental illness could seek treatment anywhere at any time without shelling out a dime, how much crime would go down? It’s not even funny how much money we’d save without having to pay for legal fees, executive salaries, golden parachutes and corporate jets. Kill the insurance companies and put the employees to work for Medicare – and they’d be union jobs too!
P.S. What do you think of Feingold’s censure resolution? Do you support it!
Call your Senators and urge them to sign on to Feingold’s censure resolution! 1-888-355-3588
September 4th, 2006 at 8:45 am
Of course medical treatment and annual medical visits to a doctor cost much. Medical treatment is always expensive. And I don’t think that there is a way to decrease these expences, I do not think that uethorities are interested in it.