Commentary On Things Present
I was certainly fooled by last week’s Supreme Court ruling on the 2010 Affordable Care Act (Obama-Care), and I think many across the country were fooled, too.
What can I say? I expected ‘the commerce cause’ – not ‘to lay and collect tax’ – to be the key domino in the Supreme Court decision on the constitutionality of the Affordable Care Act. There’s no doubt the feds have taxing authority!!! Any fool – even me – knows that taxes gobble up 50 percent of metro-New Yorker income, resulting in millions fleeing NY, NJ and CT over the last four decades.
The fabulously grand scale of American development – a 236-year experiment of free peoples and free markets – was built upon rationing by price, not rationing by sentiment and not rationing by government fiat.
You remove the sentiments of the elite, you eradicate the Machiavellian machinations of monarchs and government bureaucrats, and you have free and fair markets for all to compete ... to build better phones, better cameras, an easier lifestyle, winning basketball teams, health into the 100s through invention and innovation. Our experiment has attracted millions from across every continent to flee their country of birth to join their country of hope and destiny.
Obama-Care, passed in the dark days of 2009, dangerously injects into America’s health industry the sentiments of the elite and the Machiavellian machinations of government bureaucrats – antithetical to all that we call American.
The President’s plan is a top-down nightmare. Already, before implementation, 159 new federal offices, boards and councils have been created; and 4,103 pages of regulations have been written.
The Plan may cost up to two trillion tax-dollars this decade (the CBO recently raised their first cost estimate from $700 million to $1.3 trillion), to be sourced from new taxes and – most nefariously – ‘Medicare savings’ or lower payouts to hospitals that serve the middle class and the poor. The fate of Rockaway’s just-bankrupted Peninsula Hospital will be felt by hospitals across the nation.
To be sure, there are serious social and financial dislocations in present-day Ameri-Care: (a) health insurance is too expensive and is on a wild trajectory to go even higher; (b) too many Americans can’t afford it; (c) some – too many – do without and so are at the precipice of a health emergency.
Reform though does not mean what the President and Speaker Nancy Pelosi rushed through Congress.
The nation needs not a transmogrification of the health industry into statecare and universal care, but a resurrection with the time-tested tools of free markets.
Here’s four fast suggestions ...
(1) Health insurance provided by your boss is tax-deductible, but health insurance bought by you independently is not. Put the independent and the institutional on a level playing field by making health insurance tax deductible and portable to the individual as well as to the corporate, and cap deductibility as incomes rise.
(2) You want car insurance, you go through your options with State Farm or Allstate or Geico or Progressive on what you want, and what makes sense for you, your car, your family. You want health insurance and Oxford or Empire or United- Care says, “Ah, Mr. Stubben, here in New York State you gotta take – in addition to your $300 deductible and $50 prescription co-pay – psychotherapy, psychiatric coverage and physical therapy.” “But I don’t need or want that stuff.” “Sorry, Mr. Stubben, but the Albany Legislature has decided you must have this coverage, because it’s in your best interests.” States around the nation – and who’s worse than Albany? – mandate all kinds of coverage for their citizens on a state by state basis. Health insurance, I believe, should cross state lines and health insurance firms should compete nationally, not just locally.
(3) ‘Fee for Service’ sounds pretty good to me, as do ‘Fees for Outcomes.‘ I don’t want to be prescribed CT-scans, MRIs, x-rays, and other expensive diagnostic tests just so the MD can rack up more fees ... and that’s the argument to shift MD payments from a fee schedule to an outcomes schedule. But I also fully understand the guy (my MD) is playing Lawrence Taylor-like defense to protect himself from future lawsuits. Health Care is a science ... but like the stars and the sun, we just don’t know precisely everything about the human body, nor the universe. Like all of us, MDs are plagued by huge bills for malpractice insurance (into the hundreds of thousands per year), so that rapacious attorneys like John Edwards (who squeezed MDs and surgeons across the state of North Carolina) can run for president. The Tort Industry – a huge lobbyist in every state capitol as well as in DC – needs to be reined in with commonsense caps.
(4) RA Dickey’s pitch is pretty funky ... and maybe that’s how I might describe America’s health delivery systems. For those that can, they call their MD when their kids get sick; but for those that can’t, they go directly to the local hospital’s ER. A series of perimeter clinics – staffed by ER nurses with diagnostic equipment like x-ray machines and direct video-conference-center links to MDs – could go a long way to alleviate crowding and costs, while providing on-the-street care. Care w/b quicker, more effective and less costly.
In summary: I want my MD, as well as my phone carrier, my car manufacturer, my fashion designer, my food and restaurant purveyors regulated, yes, but free to wield that scalpel as effectively as he/she can. My life depends on it.