One problem with the "health" care "debate" is that there are many different varieties of medical care. These include catastrophic injury/illness where there is a large, short term expense, followed by a return to fairly normal life, long term disabling conditions that require various levels of cost over various levels of time, regular and predictable costs (periodic check ups , eyeglasses, teeth cleanings, etc.), and minor injuries and illnesses (flu, sprained ankle, broken arm, strep throat, etc.). Throwing everything together into one category (except dental and optometry - which are somehow not "health related" in some people's minds) just doesn't work.
Short term catastrophic care is probably best handled by a risk pool, since anybody could get hit by an uninsured motorist (or hit and run driver), have a building collapse on them in an earthquake, or be struck by certain sudden onset severe illnesses. This is where government sponsored, provided, or mandated coverage makes the most sense. Even then, there are some cases where the problem is entirely created by the patient, who is behaving in an antisocial/illegal manner that makes the medical problem likely, and the community as a whole shouldn't be expected to pay for their treatment. For example: A drunk driver with previous DUI convictions who is injured while driving drunk, shouldn't have their medical bills covered by anybody but themselves.
Our current emergency room system partially does this, providing emergency care regardless of the patient's ability to pay. Unfortunately, ERs are often used as clinics by people who have non-emergency conditions, yet who wish to get free care.
Perhaps we need more "public" clinics where people can be seen for non-emergency conditions, with a low payment. One summer when I was a poor student in Kentucky, I had occasion to visit the County Health Clinic to have a suspected brown recluse spider bite looked at. The problem turned out to be an infected cyst, rather than a bite, and I was charged $25 for the treatment, since it was simple enough to be performed at the clinic, and my income was in a certain range (the university's health services plan couldn't take care of me because it was summer break, so I had a "gap" in coverage). This was the same clinic where I received a $10 TB test to medically qualify to work with young children.
Long term conditions present a different problem. In these cases, it becomes a matter for cost/benefit analysis - unless the supply of money for medical care is unlimited, tough choices have to be made. There are various levels of treatment, that have different costs and benefits to the patient. Some conditions may be treated surgically, others with medication, and still others with various treatments (such as radiation or physical therapy). In some cases, superhuman measures might be taken to keep the patient alive, while in others, the decision might be made to control the worst of the pain, while allowing the patient to die a natural death.
It is my belief that the best person to make these choices, in terms of benefit, is the patient, or the patient's next of kin. The best person to make these choices, in terms of costs, is the person paying the costs. If people/families are not paying their own costs (or for their own elective coverage) in these situations, then some bureaucratic board, committee, or panel will decide who gets money for care, and who gets to die. If we do not keep the costs for such care in the control of the patient, then the decisions must be made by others (i.e. "death panels").
With medical savings accounts and medical tax credits (see below), a person with a long term, but manageable condition, could pay for their own treatment (or that of a family member or friend) for an extended period of time.
A person who has smoked two packs of cigarettes a day for the past 20 years (blowing their second hand smoke into the faces of others the whole time, and ruining the smell of their environment and clothing) shouldn't expect anyone else to pay for their lung cancer treatments (except maybe the cigarette company who made the cigarettes so addictive). Again, since they are participants in a behavior that is known to significantly increase the risks of harm, the public shouldn't be expected to pay, and non-smokers should actually be getting reimbursed by the smoker for the extra costs (fire, medical, and cleaning) that are created by smokers.
Similarly, a person who uses illegal drugs should have to pay (or repay) for treatment they receive for any medical problem resulting from their illegal drug use. The same would apply for criminals who are injured or who become ill as a result of committing crimes. Felons should receive a level of care in prison infirmaries that is no greater than the level of care a homeless citizen of the same state would receive. If the felon desires better care than that minimum level, they (or their family/supporters) should pay for the additional level of care. It is absolutely immoral that convicted felons in prison often receive better medical care - at public expense - than do working Americans. Felons who are on "Death Row" should receive only minimal and palliative care, since dying from illness would save the taxpayers the cost of executing them.
Medical savings plans would be a great way to assist people to save enough to cover known, recurring, and predictable expenses. Just as we have tax exempt and tax deferred plans to help people save for retirement, or for college, we could have similar plans to help people to save to pay for routine or predictable medical expenses. These plans would have to be long term, and transferable - meaning that the money would not be "lost" if it were not used by the person placing it into the account. They should be able to use it to cover their own medical expenses, or medical expenses for a family member. They should also be able to transfer money from their medical savings account to another person's account - a friend for example, and should be able to leave their account to others after they die.
Medical savings accounts should be tax free, and employers should be able to make matching contributions - as they currently are able to do with 401k type plans.
The other thing that would make medical care more affordable would be to have tax credits/exemptions for medical care (treatment and medication). This would make it more affordable for people to seek routine care, and could ease the financial burden of high cost medical conditions.
Monday, March 29, 2010
Thursday, March 25, 2010
Forget the uninsured, let's help the homeless!
As an exercise, let’s apply the Health Care Reform logic to home ownership. I think that we can all agree that having a place to live is as basic a “human right” as having health care.
According to HUD:
There are 3.5 million homeless people in America.
Over 32% of Americans don’t own the homes where they do live.
That’s over 96 million Americans who don’t own the homes they live in, and who could be tossed out on the street at any time. Added to the 3.5 million homeless Americans, that’s about 100 million people who need homes.
That’s 100 million Americans whose rights are being violated.
Obviously what is needed is a huge federal program to make sure that every American family unit or single adult owns their own home. This means that people with lower incomes will have homes given to them – at taxpayer expense
People who invested in real estate and already own more than one home should be forced to sell the additional homes – at rates set by the government, of course – or have them taken away and given to the needy, because there are a finite number of homes available, and nobody really needs to have more than one home. These people can’t really even complain because they will still have a home, and may even get to choose which one they retain – hey, it’s not our fault that they chose to invest in real estate, instead of investing in something else.
People who own “Mansions” will need to be assessed with a special tax, because their “Cadillac” lifestyles are more than they “need”, and unfair to others who live in smaller or more poorly located homes.
Since many young adults traditionally don’t buy homes, parents (or their employers, or the taxpayers) would be obliged to provide housing for children until the age of 26.
Anyone who doesn’t own a home will be subject to fines.
Members of the House and Senate, the President, and the Vice-President would be exempt, of course, and home taxes in Nebraska would be guaranteed to never go up.
We could even claim that the bill would be financed through savings from current HUD programs (such as housing subsidies), the elimination of the costly Fanny May and Freddie Mac programs, and by confiscating all student loan repayments in perpetuity. We could also claim that this would be a 50% increase in the property tax base – since it would be a 50% increase in the number of people paying property taxes. We would justify this by pointing out that only two thirds of Americans currently own their homes and pay property taxes on them (never mind that landlords pay property taxes, this is the kind of annoying “assertion” that will only be brought up by Fox news and other “nutcase” and “fringe” opponents of progress), so getting all Americans into their own homes would increase the property tax base by 50%.
********
Personally, I'm a guy who invested many years of my life into a military career. I never made more than $30k a year until I retired from the military, and my retirement check is less than $700 a month, but I actually chose to return to active duty in my early 30s because I weighed my options and decided that the medical benefits package made up for the fact that the salary wasn't going to be enough to buy a home or invest heavily.
I "invested" in lifelong medical care through my employer. Yes, through my employer - which just happens to be the government.
Now I see people who made other choices wanting to get the same medical benefits that I get, but to do it at taxpayer expense, without giving up 17 years of their life (and acquiring a 40% disability) in the service of our nation. They tell me that I am not losing anything, since I will keep my health care (although I may end up being taxed on my benefits, depending on how mush they decide my employer contribution is). I tell them that it is the same as if a housing program allowed them to continue to stay in their home, and continue to pay their mortgage, while the government gave me the house across the street for free - they aren't losing anything, except when they look at what they pay for something that someone else is getting free.
If it's going to be government subsidized healthcare for all, then I think I am owed a different compensation package for my military career - say about five times the salary/retirement. I'm not holding my breath though, because Congress and the President don't care about fairness or equity for vets.
According to HUD:
There are 3.5 million homeless people in America.
Over 32% of Americans don’t own the homes where they do live.
That’s over 96 million Americans who don’t own the homes they live in, and who could be tossed out on the street at any time. Added to the 3.5 million homeless Americans, that’s about 100 million people who need homes.
That’s 100 million Americans whose rights are being violated.
Obviously what is needed is a huge federal program to make sure that every American family unit or single adult owns their own home. This means that people with lower incomes will have homes given to them – at taxpayer expense
People who invested in real estate and already own more than one home should be forced to sell the additional homes – at rates set by the government, of course – or have them taken away and given to the needy, because there are a finite number of homes available, and nobody really needs to have more than one home. These people can’t really even complain because they will still have a home, and may even get to choose which one they retain – hey, it’s not our fault that they chose to invest in real estate, instead of investing in something else.
People who own “Mansions” will need to be assessed with a special tax, because their “Cadillac” lifestyles are more than they “need”, and unfair to others who live in smaller or more poorly located homes.
Since many young adults traditionally don’t buy homes, parents (or their employers, or the taxpayers) would be obliged to provide housing for children until the age of 26.
Anyone who doesn’t own a home will be subject to fines.
Members of the House and Senate, the President, and the Vice-President would be exempt, of course, and home taxes in Nebraska would be guaranteed to never go up.
We could even claim that the bill would be financed through savings from current HUD programs (such as housing subsidies), the elimination of the costly Fanny May and Freddie Mac programs, and by confiscating all student loan repayments in perpetuity. We could also claim that this would be a 50% increase in the property tax base – since it would be a 50% increase in the number of people paying property taxes. We would justify this by pointing out that only two thirds of Americans currently own their homes and pay property taxes on them (never mind that landlords pay property taxes, this is the kind of annoying “assertion” that will only be brought up by Fox news and other “nutcase” and “fringe” opponents of progress), so getting all Americans into their own homes would increase the property tax base by 50%.
********
Personally, I'm a guy who invested many years of my life into a military career. I never made more than $30k a year until I retired from the military, and my retirement check is less than $700 a month, but I actually chose to return to active duty in my early 30s because I weighed my options and decided that the medical benefits package made up for the fact that the salary wasn't going to be enough to buy a home or invest heavily.
I "invested" in lifelong medical care through my employer. Yes, through my employer - which just happens to be the government.
Now I see people who made other choices wanting to get the same medical benefits that I get, but to do it at taxpayer expense, without giving up 17 years of their life (and acquiring a 40% disability) in the service of our nation. They tell me that I am not losing anything, since I will keep my health care (although I may end up being taxed on my benefits, depending on how mush they decide my employer contribution is). I tell them that it is the same as if a housing program allowed them to continue to stay in their home, and continue to pay their mortgage, while the government gave me the house across the street for free - they aren't losing anything, except when they look at what they pay for something that someone else is getting free.
If it's going to be government subsidized healthcare for all, then I think I am owed a different compensation package for my military career - say about five times the salary/retirement. I'm not holding my breath though, because Congress and the President don't care about fairness or equity for vets.
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