This article is more than 5 years old. Information may no longer be current.
The political debate: Choices and changes in our health care system
Click Here to Manage Email Alerts
The government’s expanding role and responsibility for health care coverage has evolved slowly since World War ll. As we face a crisis in health care coverage in this country, reform is needed.
Expect attention to this issue to accelerate now that the three leading presidential candidates in the Democratic primaries have made health care reform a leading campaign issue, complete with detailed proposals on their Web sites. The proposals all involve more extensive programs, and more taxes, regulations and mandates.
|
It appears the Republicans will not get as heavily involved in the health care debate until after the primaries when they have selected a candidate. Then, leading up to the general election, watch for the debate to intensify on whether health care coverage is a universal right and to what extent our government should subsidize and manage it.
Not a new debate
Lee H. Igel, PhD, recently pointed out in a letter to the editor in of The Wall Street Journal that the first serious government consideration on health care came in 1854 when “... President Franklin Pierce vetoed a national mental health bill on the basis that it would be unconstitutional to regard health as anything but a private matter in which government should not become involved.”
It now appears that the government may become even more involved in providing health care. Yet a fundamental question remains unanswered: What is the extent of the basic health care that all are entitled to receive? I have never seen it well defined. How can a basic health plan be financed if it is not defined? Politicians are using general terms like “universal coverage” and “guaranteed access to quality care.” And while these same politicians agree that they personally have a wonderful health plan as members of Congress, providing that level of coverage for every citizen would not be affordable.
The coming proposals
So what can we afford? Democrats have learned from the “Hillary Care” initiatives back in the 1990s that it is almost impossible to make all the proposed changes at once. The candidates will have to plan to expand stepwise to a more socialized medicine system. This stepwise increase in government-administered programs is playing out in Congress right now with the upcoming battle over SCHIP (State Children’s Health Insurance Program). Most people can easily support the proposed $25 billion for the poorest children. However, additional proposals include another $60 billion to increase coverage to 3 million children.
|
In addition, there is another proposal to lower the eligible Medicare age to 55 years for autoworkers because the auto industry is being crushed by health care costs. Increasing the number of people covered by expanding government programs will significantly reduce the amount of private ownership of health care coverage.
These incremental changes will eventually lead to the same endpoint and just take longer. A stepwise approach does have one advantage over sweeping change — it allows for modifications along the way. Whatever programs emerge most likely will be extensions of the existing government programs we know as Medicare, Medicaid and Champus. These all currently function because of price controls, mandates and regulation. Even without fundamental change these existing programs will require more taxes and price controls to cover increasing costs.
The employer should pay
Most of these proposed programs rely on employers to pay more medical benefits. Who will really be paying more? Those of us in private practice are small business owners and it is obvious that whatever additional funds get spent on health care become unavailable for retirement plans and wages. The employees will pay for their own benefits in the end. The government and small business owners do not hand out money; they just redistribute what is available. This type of shifting between who appears to be paying for the expanded programs and who is actually going to pay for them needs to be spelled out in the upcoming debates.
Widen the debate
Before we change health care coverage completely there must be some debate on whether our current market-driven system can be salvaged. This should include the issue of continuing and/or expanding individual policy ownership, such as making health care insurance policy premiums tax deductible for individuals as they are for businesses. This is not a new proposal — Milton Friedman often questioned why companies alone got the tax deductions, and he also noted that many people want to control their own insurance coverage.
To date, the debate leading up to the presidential primaries has included minimal discussion on individual health accountability, responsibility and ownership. The debate has not considered other issues at all, including the following: high-deductible policies, bare bones and catastrophic coverage, some individual selection in their risk pool and benefits (rewards) for those with healthy lifestyles.
Hopefully, after the primaries, these issues will receive appropriate debate and help set the country’s direction. It appears that unless the voting public engages, understands and feels differently on the issues, we will follow the trend towards further socialization of the health care coverage in this country in a stepwise manner.
Douglas W. Jackson, MD
Chief Medical Editor