Sunday, January 6, 2008

Not quite Jonathan Swift eating Irish babies: a Modest Proposal to start fixing health care access in America

There is a continuing, and spirited, debate both in this country and inside Delaware regarding the future of health care in America.

With 47 million uninsured and possibly as many as 50 million under-insured citizens, it would seem that nothing except a MAJOR structural overhaul of the health care system can achieve--I don't know--social justice or a healthier America!?

But what could Congress do tomorrow to improve health care in America?

According the Kaiser Commission on Medicaid and the Uninsured, nearly half of the increase (48%) of the uninsured population occurred in middle-class families making $40-80,000/year.

At the lower end of the spectrum, Medicaid and SCHIP, Kaiser argues, are making inroads to provide basic coverage, but in among middle-class families whose employers do not over coverage (or whose coverage is too steeply priced to afford), but the situation is growing dramatically worse.

Who is to blame? Kaiser has an easy answer: the Bush administration and anyone who opposes massive Federal funding of health insurance:

The most striking finding in this brief is that almost half of the increase in uninsurance among children was in families with incomes between 200 and 399% FPL [Federal Poverty Level]. This is the income group that the Bush administration has argued should not be eligible for SCHIP expansions. While public coverage is generally available for lower-income children, it is less available above 200 percent of the federal poverty level. The decline in employer coverage in this range with no offsetting increase in public coverage contributed to a substantial drop in children’s coverage in this income range. Permitting states to have the flexibility to expand Medicaid and SCHIP coverage to higher income levels would help to ameliorate the decline in employer sponsored coverage for children in middle income families.

Here's a simpler solution that doesn't create new government bureaucracy:

1. Make all premium payments and out-of-pocket medical expenses 100% tax deductible for everyone not otherwise covered below. (Somebody explain to me, please, why this isn't already the case if we're so worried about people's health care being financially ruinous.)

2. For all individuals/families under 400% of the Federal Poverty Level who are not covered by Medicaid and/or SCHIP, provide a $5000/person tax exemption for medical expenses OR a 100% tax credit for premium payments and out-of-pocket medical expenses to those who itemize their taxes. Phase this exemption/credit out in graduated steps between $80,000-180,000 annual income, with such families then falling under item 1.

A. In the event that an individual/family does not possess a tax liability that reaches $5000/person, provide the employer with a tax credit for up to that amount of Federal payroll taxes and require that this amount then be paid to the employee in the form of a "tax-free health care payroll tax rebate."

3. Allow each individual a one-time "catastrophic" health care tax credit of an additional $10,000/year for a five-year period; should the individual (or guardian) not be making sufficient income to receive the full benefit of this credit, issue a rebate through the employer of ALL Federally mandated payroll deductions until the $50,000 ceiling has been reached. There should also be a provision that allows such an individual/family to file to have all Federal withholding stopped immediately until the ceiling has been reached.

4. Allow Federal Emergency Medical Loans against the catastrophic benefit listed in item 3, with the benefit serving as security.

5. Fund this program by:

A. Replacing the retirement plan for Federal legislators with Social Security (making this replacement retroactive for all former legislators who have not reached the age of 65).

B. Cutting all Federal discretionary spending 10% across the board. (Don't think it can be done? Look up Mills E. Godwin as Governor of Virginia--he served once as a Republican and once as a Democrat--and while he was a sometimes champion of resistance to public school integration, he was also famous for cutting the state budget every time he saw it drifting toward the red. I can remember his two-sentence press conferences: "As of this morning every state agency has taken a 10% budget cut. There will be no exceptions.")

C. Not worrying about it. (No, I'm not being cute: this is always the strategy Congress and the President employ when they want something really badly.)

OK, so I know this is something that (A) is very rough and could be improved upon easily; and (B) could never pass in our current Demopublican system because it doesn't allow the government to maintain regulatory power over people--and (God help me!) it actually allows people to pay less taxes.

It gets to the issue, however, that if in fact the average health care cost for an American citizen is somewhere in the $6500-$7800 range (see all my previous posts for the sources of this range), then the elimination of $5000 of Federal taxes SHOULD GO ONE HELL OF A LONG WAY toward meeting these expenses.

Am I going to mandate any restrictions or spending guidelines that people have to follow when receiving these funds?

Not on your life. It was arguably their money in the first place. If people decide to go out and blow it on a 56" plasma TV, then THAT'S THEIR CHOICE, because IT'S THEIR MONEY.

My point (and I do try to keep my hair combed over it): there are far more elegant and cost-effective ways to get American citizens--especially those in the middle class--access to decent health care than all the convoluted, government-controlled Ponzi schemes that both wings of the Demopublicans are hawking this election year.

The simplest of those ideas is this: stop taking people's money away from them.

1 comment:

Alan Coffey said...

Hmm. I pay $500 per month to insure my family of four. I have a $7500 deductible per year. Basic checkups are covered 100%. At worst, I will have to pay $13500 per year for health services. We have been on this plan for only two years but our average "deductible hit" is about $1200 AND I WATCH THE EXPENDITURES LIKE A HAWK.

Tax deductible insurance payments would help a lot. A one time catastrophic fund would "feel" good too.