My Health Care Preference for America

07/10/2007

Paul Munnis


Health Care for Americans is fraught with politics, jingoism, and mythology. Michael Moore has pointed that out in his recent film and politicians know the demand is there and that they need to find a way to make it happen.

"Plans which minimize the disruption to the existing system are more likely to succeed than plans that rip up the existing system and start over," said Jonathan Gruber, of MIT, the author of much of the Massachusetts healthcare plan who has consulted with the three leading Democratic campaigns about their health plans. "It doesn't take a genius to see that. That's not to say that plans ripping it up wouldn't be better -- I just think they're political non-starters."

Two of those candidates, Edwards and Sen. Barack Obama (Ill.), have endorsed the idea of universal coverage and suggested ways to achieve it, and the third, Sen. Hillary Rodham Clinton (N.Y.), is expected to outline her ideas in the next few months. Obama's plan does not require adults to obtain health insurance, a distinction that Edwards has tried to exploit because his aides say that without such a requirement, Obama's plan would not ensure coverage for everyone.

Building on two major things that Michael Moore pointed out is I think the proper direction and it does build upon what we already have in place and working.

The first is to build upon Medicare, a program that Republicans seek to destroy yet that is wonderfully workable today for millions of Americans. Medicare is effective, and already in place. Medicare works in spite of all the nonsense about “socialized medicine” that we hear from the GOP.

Therefore to me the next phase is to place all uninsured children onto Medicare. Do it now. Pay for it by shifting Medicaid funds over to Medicare. At that point we will have the two most vulnerable parts of our society covered, the young and the elderly -- a good start.

The second thing is to require Veterans to convert over to Medicare.

Veterans should be moved under Medicare and the Veteran funds shifted to the Medicare account to pay for them. Many will already be receiving Medicare benefits in addition to the Veterans Benefits and that might mean some savings. A careful examination to assure that they do not move backwards in care and coverage is needed. If necessary, Veterans extensions can be created for Medicare supplemental coverage to cover things like Post Traumatic Stress Syndrome.

VA Hospitals should be joined with Walter Reed and other military hospital facilities into a Military hospital complex run as a quasi government agency open to all but with preference given to our military families. Present treatment plans should be preserved in the shift.

All Tri-Care members must then be shifted onto Medicare and given preference at the VA hospitals and the budget for Tri-care military insurance for soldiers and their families and all military retirees would then be shifted over to the Medicare people for payments.

The next thing is to shift the remainder of the Medicaid recipients over onto Medicare and end the Medicare program for good. Many of these people are welfare recipients and they will be much better off under Medicare.

What is now left is the vast majority of working men and women in America who currently pay into healthcare plans, plus they pay Medicare, and Social Security, with payroll taxes. Along with them are their employers who must match the Social Security contribution. I would shift them all onto Medicare and eliminate payroll taxes altogether for both worker and employer and replace that with a national sales tax of 7% on sales of goods and services. The revenue from this when combined with the shifts in other government insurance accounts should cover all insurance costs. Some would go to Social Security and some would go to Medicare. The national sales tax rate would be adjusted up or down as needed to meet projected costs. All members of society would be paying into health insurace according to their purchasing deisions.

There is the matter of coverage of pharmaceuticals (drugs) for those on Medicare. The present system is a mess with donut holes and private health policies and having many confused people involved. I would replace that with a Medicare schedule of payments for drugs locked into exact parity with the Canadian drug payment schedule at the U.S. dollar conversion rate. I would also require that pharmacies, hospitals, and all those dispensing drugs to patients accept those fee schedules in full payment and thus eliminate the present drug plans for the elderly. People who need drugs would get them and without making payment.

Insurance companies wanting to create a supplemental set of policies and offerings for sale to employers and individuals would be free to create and market those as Medicare supplement policies. Employers might want to entice workers with supplemental policies. That would be up to them.

I would phase these groups over to Medicare at 12 month intervals and over a period of five years giving Medicare sufficient time to manage data entry of recipients and to work out any kinks.

When it is completed we would match the French System and would now have the highest quality medical care in the world for our people.

For our health givers they would only need to use the Medicare submission process, something they all now have in place and a fully debugged system that works just fine.

People would not be paying payroll taxes, no money would change hands when treatment is required, drug prices would be regulated for all of North America and be covered under Medicare, and everyone would have healthcare as good or better than what they now receive.

I say let’s stop messing with this as a big insurmountable obstacle. It can be done, we know it will work. It will end up more effective in the long-run and can be managed cheaper once completed. If we move people over in big groups shifting them and their funding in parallel it can be made to work without ringing up any long term debt.

Let’s not settle for less. We owe this to ourselves.

As we ditch the cost of the Iraq War, begin to manage down our national debt, and take on the trade deficit, we can also do this health system modernization and outfit America for the 21st Century.