The Sovereign Mind

Free thought on politics and real life

Posts Tagged ‘welfare

How to Fix the Health Care Fix

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Now that health care reform is passed and signed into law, Republicans say they will try to repeal the law when they are back in power. Repealing isn’t going to happen, since it would take a super-majority that the Republicans won’t have for a long time. By that time the law will have become settled along side Medicare and Social Security. But, it might be feasible to adjust the reform, since even some moderate Democrats might come on board for that.

So, how would I fix the health care fix?

The way I see it, the main problem with the reform is its cost. If we could provide good insurance to all Americans without breaking the bank, I’d be all for it. The CBO scored the bill as a deficit reducer, but it also raised a number of questions about how the funds are raised, and whether the proposed savings could be realized. I won’t go into the details of that discussion since the argument has been laid out elsewhere.

We should keep the measures that seek to eliminate waste in Medicare. However, considering that Medicare is underfunded, the money saved from those measures should be used to extend Medicare’s solvency, not fund a new entitlement program. That blows a huge hole in the funding mechanism used to pay for this reform, so we’d have to scale back the bill’s spending. The bulk of the spending in the bill is for subsidies for people to buy insurance. Instead of subsidizing comprehensive health care insurance, we could pay only for catastrophic plans. For the poor who don’t qualify for Medicaid, the government would pay 100% of a catastrophic plan, which would include coverage for people with chronic illnesses. The subsidy would be on a sliding scale, with those making 400% of the poverty line not getting any subsidy. Of course, if we are only subsidizing catastrophic plans, we cannot mandate that everyone buy a comprehensive plan, so the mandate to buy insurance would have to be scaled back as well. Individuals would only be required to purchase a catastrophic plan.

Of course there are some objections that can be raised to my plan, but before I get to those, let’s look at some of the supporting points:

First, this plan maintains several of the positive aspects of the current reform, but with a lower price tag. Having everyone covered with a catastrophic plan would ensure that those who get diagnosed with serious illnesses do not get forced into bankruptcy due to their health status. We would not be paying for people to show up in the emergency room to get uncompensated care. People with chronic illnesses would not be denied supplemental insurance since care related to their condition would already be covered by their catastrophic plan.

Second, giving people the choice to buy supplemental insurance, or pay for preventive care themselves, will make them more cost conscious, thus reducing the cost of health care and reducing the demand for unproven treatment and technology, which the CBO says is a major driver of health care costs. To enhance this effect, I’d also support ending the tax exempt status of employer-based health benefits, but that can be a separate discussion.

Lastly, some people choose not to go to doctors except for in emergencies. Your or I might not agree with that lifestyle, but why should those people be forced to buy something that they will choose never to use?

Now, on to the obvious objection: subsidizing and mandating only catastrophic plans will leave some people without coverage for routine, preventive care. However, more prevention (at least the kind that you pay for) doesn’t actually lead to lower health care costs. Sure, treating someone with a serious illness is expensive, but so is testing millions of people who won’t ever get the illness. Of course, cost aside, most of us want to do what we can to avoid serious illness, but shouldn’t we be free to make that cost-benefit analysis for ourselves? However, it is true that there will be some lower-income Americans who want supplemental insurance to cover routine care, but can’t afford it. I’d love to be able to give them that coverage, but we simply can’t afford it. We support the poor in many ways through many welfare programs. In fact, we help the poor so much that the effective marginal tax rate can actually exceed 100%. We can’t afford yet another welfare program.

I doubt I’ve convinced everyone, but I hope I’ve at least helped the discussion get started. Many on the left will object to stripping out the generous subsidies, and many on the right will object to any proposition that doesn’t have the word “repeal” in it. So, it would be a tough sell, but hopefully most of us can agree that any “fix” to this health care fix has to be focussed on making it more fiscally sustainable.


Written by Mike

March 28, 2010 at 9:56 pm

Does Limbaugh Have a Point?

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I know I’m immediately going to lose credibility with a lot of people when I say that I think Rush Limbaugh might have a point about something. Let me be clear that I think he’s a radical, who I disagree with more often than not. For example, of course I think it was wrong and offensive that he claimed that Colin Powell’s endorsement of Barack Obama was because of race.

I work during the day so I don’t often listen to Rush except when I happen to be in the car for some reason and catch his show. Today I heard something that caught my attention. He was responding to Obama’s infomercial last night. I thought the infomercial was well made and showed him off in the best light possible. However, something bothered me about the families he portrayed. It seemed a little too much like the last Michael Moore film I watched. But I couldn’t quite put my finger on what was bothering me, until I heard this (I’m cutting out some the fluff, but feel free to read the entire piece if you want–some of which I very much think is over the line. I’m trying to focus in on this one point):

Rush: Okay. Here’s my help. Here’s my assistance. These are just some questions I had. Ms. Sanchez, are you aware of the food stamp program? Ms. Sanchez, are you aware of the Medicaid and SCHIP programs? That’s the health care program for children. Are you aware of the school lunch program? Ms. Sanchez, are you aware of the public housing programs we have?… Obama wants to create the impression that the New Deal, the Great Society, and everything in between have never happened! We have so many relief programs out there. The food stamp program continues to get larger and larger, and they advertise for applicants…

You can seek the help of the scores of church and other charities in your area for help. You can apply to the drug companies for compassionate use assistance in buying your prescriptions. The Great Society, the New Deal, it’s all out there. We’ve already set up systems to help people in this circumstance, and yet it’s like we’ve done nothing. It’s like our country has no heart. It’s like our country has no compassion, and Barack Obama for the first time in American history is going to come along and take care of people who find themselves in problematic circumstances. You know, folks, we have never cared for people before in this country. We’ve never tried to help people who are down and out. Only Barack Obama is going to bring this about for the first time, only Obama. The Great Society? The New Deal? Why, they never happened. So, do we really need to destroy our economic system for Obama’s four families?

Now, you can make a reasonable argument that programs that Rush is talking talking about are insufficient to meet our societal obligations (whatever you think they might be). However, where I think Rush has a point is that Obama seems to want to pretend these programs don’t even exist. He did not say, “Mr. Jones applied for Medicaid but was denied” or “Mrs. Smith got food stamps but they just weren’t enough to feed her kids”.

The fact that Obama doesn’t mention these programs could mean one of two things:

1) It’s a political ploy just to try to get more votes, or…
2) He really believes these programs aren’t just insufficient, but are so flawed that they should be severely reformed or discarded in favor of new programs. If this is true, that lends some validity to the “fear tactics” used by the right that Obama will usher in a new nanny state society. It’s one thing to argue that the current programs need to be expanded, it’s quite another to argue that we should radically change the goals of our economy to be welfare oriented instead of growth oriented.

I wrote this post a few days ago but didn’t post it, thinking perhaps I was being too cynical about Obama. I think it’s arguable whether Obama intends to send this message. I think his reasons are more along the lines of the first (political ploy). I don’t think he wants to discard everything and start fresh. I think he is would support the traditional Democratic line that the programs we have just need to be expanded, even if his rhetoric seems to exceed that.

However, whether Obama intends it or not, there is no doubt that the message of a new “we’ll take care of you” society is taking root in some of his supporters, which is reason enough for concern among conservatives:

Written by Mike

November 1, 2008 at 1:38 pm