Friday, September 4, 2009

YouCare: It's Like ObamaCare, But it Might Just Work.

Sometimes I think the only reason the ongoing American health care crisis hasn't degenerated into full scale civil war is because both sides know the system couldn't sustain the sheer number of casualties. Not yet anyway.

Fortunately, should everyone come together and agree that my health care reform proposal is, in fact, the most viable (and palatable) option, both crisis and war could be averted. No thanks necessary.

However, I think many of us have ideas about solving the health care crisis that fall outside of what has become the false dilemma of our times: socialism or status quo.

This is America, damn it. We have alternatives. But these alternatives must be brought to light. Exercise your freedom to speak and think and go outside the confines of party affiliation and offer your own health care reform proposal in the comments of this post. And exercise your freedom to respectfully tear each other's proposals to shreds.

Here is my own.

Under cries of socialism, those on the right seem to prefer weeping and gnashing of teeth over surrendering any more of the health care system to the government (while ignoring the fact that a significant portion already falls under their direct influence and/or control). Meanwhile, basking in the glow of a greater sense of humanity and compassion, those left-of-center talk about universal health care as though it should be a given, the ends so thoroughly justifying the means that the means, whatever they are, should be a mere afterthought.

I keep hearing people refer to health care as a right. But this cannot be so. Rights by definition cannot be administered by the government, only protected. Yet, even in my personal life, I am keenly aware of hardworking people who face economic ruin because of either chronic or catastrophic health crises. These are not people looking to suck the federal teet, nor are they among the uninsured.

Then I look at current federal spending.

Right now, there are more than 1,800 federal subsidy programs. Collectively, these programs amount to billions upon billions of dollars, spent on everything from speciality crops and healthy marriage promotion to tattoo removal, pre-school anger management courses and turkey hunting.

Wild federal subsidies have reaped two widespread negative consequences. First, they have turned state governments and non-profit organizations into federal agencies and contractors, respectively. Second, they have turned our tax revenue into a monstrous cookie jar for the unprofitable to cram their mitts and grab what they can.

Point being, the government has been redistributing our wealth for decades. Federal assistance programs have been growing exponentially since the 1960s, and the economic stimulus added rocket fuel to the blaze.

I propose a simple compromise: stop giving money away to failing industries, wild schemes and short-sighted bleeding hearts and put that money into health care reform.

Effective health care reform should focus on two fundamental principles. One, restructuring the market of health coverage for Americans who can afford it. Two, providing a viable public option for those who cannot.

I've already written on restructuring the private insurance industry, breaking free from the employer model, empowering individuals with an open, competitive and tax-incentivized insurance market.

For those who cannot work, or those who work and cannot afford coverage to provide them the care they need (those with chronic or catastrophic illnesses or injuries) a quality public option should exist.

But this public option should by managed state by state, with federal funding doled out according to each state's unique needs. As former Senator (and mechanical engineer) John Sununu (R) so eloquently argued, efficiency requires a 'short control loop'. "Your shower faucets are a short control loop. You turn on the cold faucet, the shower is cold. You turn on the hot faucet, the shower is hot. You fiddle with both faucets, and you take a shower. Now imagine your second-story bathroom has its shower faucets in the basement. That's a long control loop. You turn the water on, climb the steps and get in the shower. It's too cold. You wrap yourself in a towel, go down two flights of stairs dripping water all over the house, go back upstairs. It's too hot. You go back downstairs, etc."

Sununu's extended shower metaphor firmly applies to federal oversight. Washington should merely empower states to manager their own public health care options. The first step in doing so would be to streamline (i.e. do away with) Medicare and Medicaid as they currently exist. This frees up an incredible amount of funding right from the start.

Next, every state, after thoroughly examining their specific health care needs and petition Washington for the necessary funding. Once funds are dispersed, states are solely responsible for managing them, subject to petitions for subsequent increases. That is, instead of senators withdrawing a quarter million federal dollars for pre-school anger management, they might withdraw the same amount to provide an underserved region of their state with two qualified primary care physicians.

Which brings me to my next point. Qualified physicians.

In 2008, the average medical student graduated with more than $150 thousand in debt. The real cost of practicing medicine, including the outrageous expense of liability insurance, is steering an increasing number of brilliant students away from the medical profession. Those who remain are less likely to pursue fields which promise lower income (primary care) or greater liability (surgical specialties). And a nation cannot survive on dermatology alone.

Thus federal funding (in cooperation with tax-incentivized contributions from the private sector) would make public medical education free for those students smart enough and hardworking enough to make the cut. Students accepted into elite private institutions would also have the ability to petition for financial assistance. This assistance would be conditional upon things like practicing in underserved populations for a certain period, or achieving board certification in a given specialty.

Upon graduating debt free, these students will then have a decision to make. Public or private sector.

Freeing up the health insurance market for individuals will maintain the private sector of medicine. Physicians will have the ability to open a private practice, much like they do now, seeing a greater number of patients than current insurance networks permit.

I won't tackle tort reform here, but suffice it to say whatever measures need to be taken to make liability insurance as affordable for physicians as health insurance should be affordable for working Americans must be taken, period.

As for the public sector of medicine, here are the basics. Think of it as the public sector of law, a better-funded, better-managed Public Defender of Health. Physicians can opt to serve in either state-run or state-contracted medical offices and hospitals. The pay scale would be similar to those found in the military or among elected officials. These physicians would earn less than their private sector colleagues, but their income would not be taxable. Those working in state-run facilities would receive liability coverage, while those under contract would receive assistance to purchase their own.

Further, private sector specialists can be offered incentives to take on 'pro bono' cases, in the event that they are "the" physician to take on a rare or particularly troublesome ailment. These incentives would also be available in the event that private physicians simply want to help take the burden off of the public facilities.

Of course these state medical facilities would be given to the same headaches as any other state-run office, and the free health care would cause long wait periods and other administrative headaches. But the quality of care and overall access would be far superior to what is available now, while preserving the rights of financially stable/successful Americans to pursue the best care their money can buy.

First and foremost, this would require Americans to reach some kind of agreement. Perhaps if we can't agree that health care is a right (I, for one, think that it isn't) we can agree that providing for the health and general wellbeing of American citizens is a compelling state interest, far more worthy of our tax dollars than the majority of things they are currently wasted on.
As George W. Bush once said, you are either with me or against me.
Bring it on.


  1. I understand that you are presenting a compromise here, and I agree that the changes you’ve proposed would likely lead to circumstances better than the proposed “ObamaCare” and even the status quo. I too am frustrated that there only appears to be two possible outcomes from the current healthcare debate, either the left gets their way and we get ObamaCare or the right succeeds and things stay the way they are right now. In my opinion, neither of those options is satisfactory. I agree that your system would probably provide better coverage to those who are currently doing without, and also help restore some direly needed free market standards to the health care industry.

    However, as you said, “This is America, damn it. We have alternatives.” I just can’t bring myself to support a compromise when it’s the alternative of outright victory that I desire. In the fantasy world where I live (a fantasy world free of fantasy altogether, where people operate on reason and intellect) this is the health reform that I would propose:

    To keep this short, let’s just say that I would propose most of the same changes to private sector health care that you mentioned (tort reform, restructuring tax law to balance insurance provided by an employer with insurance purchased personally, etc.).

    Also, I agree that federal subsidy programs are a huge waste of funds and would support their abolishment. However, here is where my plan differs from yours. You propose we use the money we currently use to subsidize whatever nonsense it is we are subsidizing, and simply redirect it to essentially subsidize the health of people who are failing (for whatever reason) to provide it to themselves. As the old adage goes, “Two wrongs do not make a right.” In my mind, while this may solve some of the issues at hand in this debate, it does nothing to change the key problem at the root the whole argument: wrongful redistribution of wealth. Taking part of my hard earned paycheck, against my will, may seem nobler if the money is used to provide for the health of the disadvantaged rather than for “preschool anger management,” but it’s still wrong. It’s still robbing Peter to pay Paul. You’re just paying Paul in doctor visits instead of dollars.

    I would like to suggest, instead, that we take the money used for federal subsidies (and medicare/medicaid) and simply return it to the hands of those it was taken from. I say we dramatically lower taxes. Perhaps, if healthcare costs lest as a result of the private sector changes we’ve discussed, and if people got to keep more of what they earned, there wouldn’t be so much of a health care crisis in the first place.

    For the people who still cannot afford their own healthcare, I feel it’s more appropriate and efficient to allow private charities to assist them than to create a new government entitlement program. After all, people have a choice about which charities they donate to, if at all, so the charity has an incentive to spend those donated dollars wisely. Private non-profits would certainly provide more “care” per dollar than any government option. Some of the funds siphoned from federal subsidies could even be used to increase tax-incentives for donating to such charities. Also, with the rest of the money being pumped back into our economy the resulting prosperity would certainly lead to a large increase of charitable donations nationwide. It is no coincidence that the wealthiest nation on earth is also the most generous. If you need convincing on this point, look here:

    Under my health plan, would people who are currently unable to afford health care still receive a lower quality of care than people who can provide for themselves? Most likely. Would there still be a few people who fall through the cracks altogether? Sure. Would my plan be fair, capitalist, morally sound and lead to more prosperity, freedom, wealth and health for Americans in general? You bet your ass.

  2. Just my opinion...Opening the Insurance market to consumers in every state, serious tort reform, and regulations on the insurance industry regarding pre-existing conditions should be the main focus of health care reform. We have seen all to well how the government manages health care, from the service they provide our veterans to medicaid and medicare. They can't help but botch something completely when the federal govenment gets involved.

    I also don't want tax dollars of any kind going to support illegal immigrants in this country. We are a country of laws, not of hand outs. Id illegals want medical care, unless it is immediately life threatening, they need to return to their own country, unless they can pay the fees required for medical procedures in the US, or have medical coverage through a licensed US health insurance company. This would make sure our medical facilities and practicioners are compensated for their costs.

    Of the 47 million that Obama continues to like to throw around as "Uninsured", the fact is only around 3 to 5 million people are in a position to need health care that they are not receiving or cannot afford or currently have coverage for. I agree that the states, not the federal government, should oversee this issue on a state by state basis. To me this only makes sense.

    If my tax dollars go for anything health care related, it should be for senior citizens. These people who worked their entire lives to make this country great, how have done their time and paid their dues. They should never have to worry about prescription medications or being taken care of in their twilight years. No one should have to decide whether they will eat, pay their electric bill or get their prescription filled with the small amount of money they have on a fixed income. I will ever understand how we send billions of dollars overseas each year, yet we cannot take care of our own at home like we should.

    My opinion of Washington DC and our leaders right now is that the health care issue is so agenda driven that few are looking at the issue of real reform. Regardless, a government ran or socialized healthcare system is not the answer in America. It isn't working in Canada, it isn't working in Europe, so what makes them think it will work here? We already cannot afford what they have us paying for.