Allow me to begin by openly stating that I wholly despise Socialism, Fascism, Communism, and all ideologies of similar ilk - that being said, one of the reasons I so ardently defend the First Amendment is because no idea is wholly devoid of merit. A prominent topic along these lines is a general approach towards fundamental health care within the United States.
The fiasco surrounding the 'Affordable Care Act' (colloquially known as 'ObamaCare') is nothing short of a total disaster. Despite the protestations of brainwashed leftists, 'insurance coverage' ≠ being able to receive health care - those $5,000 to $15,000 deductibles means that you're forced to spend that amount on medical services before your 'coverage' pays one red cent towards them. A scant 5% of the population accounts for over 50% of health care expenditures, so meaning that THESE people actually benefit from ObamaCare but the overwhelming majority receive no benefit whatsoever from this 'legalized' extortion racket. More than eight million people voluntarily paid the tax penalty and a significant portion of Americans (estimates range from 28% to 53%) pay neither federal income tax nor ObamaTax.
Some young idealists point to other nations in regards to socialized health care (as I said before, no idea is wholly devoid of merit) yet they eagerly buy into half-truths or otherwise fail to see The Big Picture™. These idealists will laud the system used in Norway without considering that all residents are forced to pay exorbitant taxes (in the vicinity of 70% of their total earnings) to fund this 'free health care'. Countries like Greece and Venezuela are facing economic collapse and even open rioting in the streets because their GDP is so low that even the whole of their citizens' incomes aren't sufficient to meet the expenses of socialized medical services.
So what is one to do?
There's much to be said for old bromides - they exist because they are simple wisdoms which ring with truths. Among the greatest of these is the adage "an ounce of preventions is worth a pound of cure" which, as applied to health care, means that it is far more cost-effective to provide basic health maintenance that to let health issues fester to the point of requiring considerable intervention. We also have the precedent of public education: where even the most rudimentary of education was once the sole pervue of those who could somehow afford it, we now take a high school education (and some community colleges) for granted.
This touches on the concept of Enlightened Self-Interest; how doing things to your own benefit can confer similar benefits to others. The classic example of this is two children sharing a cake - the first child decides how to cut the cake in two but the second child gets to choose which piece they want, so meaning that a greedy first child MUST cut the cake fairly and evenly in order to ensure that they wind up with as much of the cake as possible.
These concepts combine to arrive at a simple, straightforward course for how to address the issue of public health care. Of course, the real trick comes down to implementation.
Part I: Funding
The first step in implementing this plan involves abolishing the Infernal Revenue Service and federal income tax with a nationwide 20% sales tax. I will elaborate in another post (and link here accordingly) but key highlights include:
- Sales tax is already monitored and collected automatically, requiring only a single additional ledger column
- A portion of collected funds are pooled at a municipal and regional level to fund local services
- Essential goods (groceries, medicines, hygiene needs, etc) are wholly exempt from such taxation
- Prorated over five years on all motor vehicles (20% on current year model, 0% if five years or older)
- Prorated over ten years on primary residential properties (20% on new homes, less 2% per year of age)
Most sources place federal expenditures on health care at roughly 46% of revenues. The change in how government taxes are collected (in addition to the following surcharge) makes it difficult to properly assess how much of these revenues should be appropriated towards funding health care, but I would recommend an initial apportion of roughly 30%. Not only would the flat tax (as outlined above) result in slightly greater revenues but also reduce expenditures by eliminating the bloated bureaucracy of the IRS.
This funding would be supplemented by an additional federal surcharge (pooled at municipal, regional, and national levels accordingly) of 10% which would be levied against products known to pose contributory health risks - tobacco products, alcohol, etc. This would also be levied against many restaurant items (particularly fast food), adjusted to reflect their relative health impacts and the amounts to be wholly included within promoted / menu prices.
(And I say this as a smoker who regularly patronizes fast food establishments and occasionally purchases alcohol.)
Part II: Services
The primary focus of this approach is on health maintenance and preventative care. Key features include (but are not limited to):
- Recommended screenings and examinations (breast/prostate exams, cancer screenings, physicals, etc)
- Primary care for common outpatient visits (cold & flu, lesser injuries, etc)
- Common pharmaceuticals provided to patients at no cost (when properly prescribed)
- Providing both male and female fertility resources (condoms, birth control pills, etc)
(While that last may raise some eyebrows, consider the near-negligible costs of these options compared to those associated with alternatives ranging from problematic pregnancies to full-on abortion. I wholly despise abortion and feel that the best solution is to help avoid the pregnancy in the first place.)
This is not to exclude emergency services and/or care for more serious medical conditions, put to emphasize care and screenings in an effort to prevent and avoid minor maladies escalating into more chronic ailments - the precise opposite of how medical care in the United States is so often practiced.
Included in this approach is an extensive revamping of Medicare, Medicaid, and other such federally-funded medical assistance programs. By more fully integrating these programs with an eye towards health maintenance and preventative care, health care providers can benefit from volume discounting - thus minimizing their own expenditures while simultaneously increasing both the quantity and quality of services provided.
The only thing the majority of patients are expected to provide is a valid Social Security number.
Part III: Lifelong Care and Pre Existing Conditions
The primary caveat to this approach towards health maintenance and preventative care is that it emphasizes care for the 95% who are generally healthy as opposed to the 5% who demand the majority of health care expenditures. While I don't have a bulletproof plan in this regard, I do have some key recommendations:
- Chronic pre-existing medical conditions will require the explicit purchase of supplemental medical coverage.
- Providers and purchasers will benefit from a free and open marketplace to optimize consumer value.
- All such patients will receive income-based subsidies to assist with associated premiums and deductibles.
This portion accomplishes the key aspect which the ACA was meant to address in as practical a means as possible. To paraphrase the typical "99%" rhetoric, those who are receiving the most benefit from federally-funded health care should be paying the most for it - tempered, of course, by their relative capability of paying for it. As with the "vice tax" outlined in Part I, those whose lifestyles are prone to result in additional medical expenses (smokers, drinkers, poor eating habits, etc) are also paying more into the collective funds.
The above is, of course, a rudimentary outline. A formal bill / proposal would require more research and access to more information that I am capable of on my own (in addition to greater fluency in legalese), but this should at least provide a modest template and a general heading in regards for how to reform health care in the United States.
VINCIT OMNIA VERITAS ~ TRUTH CONQUERS ALL