Health Care or Health Insurance... What are we debating?

I think that we Americans are in the middle of a HUGE kerfuffle, arguing and wasting massive amounts of time and emotional capital when we haven't even truly defined the debate. Hear me out on this.

No more than 60 years ago, "all-you-can-eat" health insurance was practically unheard of. In fact, very few Americans had any form of comprehensive health insurance. There were various insurance and hospitalization plans available through work and kids could get some insurance for a few dollars while enrolled at school but most families "winged it" with medical expenses. During the 50s, 60s and early 70s going to the doctor was affordable. Most of us early baby boomers were born in hospitals and the payments came from our parent's pockets.

During the 70s and beyond, more expensive medical procedures involving sophisticated surgeries, treatments and medicines evolved. Suddenly, the cost of health care ballooned. Instead of curing common diseases and treating maladies such as broken bones, tonsillitis, heart attacks, palliative care for cancer, etc. the medical industry started developing drugs and treatments for diseases and syndromes no one had ever heard of. Was this a natural progression or did the "medical industrial complex" go out looking for expensive things to cure as a way to boost profits? Who knows, but whatever the reason, it became possible, and then expected, to have just about any medical problem, diagnosed, treated and then paid for by insurance. It had to be covered by insurance because no normal American could afford the high-priced fees. Instead of just living with psoriasis, there was now a treatment for it. Acne, athletes foot, gout, obesity, trick knee, ski injury, flu, ear infection, chipped tooth, scrape from falling off of a bicycle, everything became a medical issue and off to the doctor or emergency room we would go. Somebody had to pay for it.

Hospitals used to have open wards with rows of beds. Even a semi-private room was an expensive luxury back in the day. TV in the room cost extra, then private rooms became the norm where now there are practically no rooms which are not completely private. What is the point of me bringing this up? The point is that what we now consider essential for survival from a medical point of view is really much more that what is needed to sustain life and health.

Everyone bemoans the high price of medicine but where is the economy? If the government mandated that every American would receive transportation as a basic human right, would everyone get a Mercedes or at least a really, really nice Chevrolet? If food was deemed a basic "right" under the Constitution, would everyone have access to a personal chef preparing meals with the freshest of ingredients? If housing was guaranteed (uh, it is, isn't it?) would all comers get a McMansion in the best school district? So, why is medical care the exception? There has to be an agreement on basic medical care.

Back to the premise of the argument. I think that even though there is nothing in the Constitution of the United States giving the federal government the right to provide food, water, shelter, education and medical care to citizens of our great nation, it has become an accepted and expected benefit of being an American (and being an illegal alien, as well.) I will stipulate that point. So, how do we get to consensus?

As President Trump said during his campaign "I am not going to let Americans die on the street for lack of medical care." I do not think that any of us (even members of the Freedom Caucus) want this to happen. I am not clear as to what the far right would do to provide for those who cannot or will not provide for themselves, but that goes beyond the scope of this blog post. We have to come up with what the baseline level of care is and who should pay for it before any legislation can be discussed, proposed and passed. This is where the Republicans failed and failed miserably.

My thought is that there needs to be a basic, "generic", white label version of health care which will provide life-sustaining medical care to those in need and basic preventative care for everyone who will avail themselves of it.

Much is said of preventative care, but beyond the occasional flu shot or annual physical for the job or to play on a team, few of us do anything preventative. Most of us do not have the time to take off half of a day to see a doctor, even if it is free. Those who are not employed probably have their own set of excuses why they can't go in for preventative care. Whatever the reason, we Americans generally suck at taking care of ourselves until something bad happens. When that occurs, we need to have a viable Plan B.

The US must provide a system of basic medical care facilities which are available for all people to use. This actually exists throughout much of the nation. Urgent care or "Doc-in-a-Box" practices are available everywhere. Wal-Mart could provide them within each store if they wanted to. There should be no reason for anyone to go into an emergency room except feet first. Build an urgent care facility next to each emergency room for emergencies which are not really emergencies. If an individual cannot pay for medical care, then they get the generic version, plain and simple. No frills, no luxury, just basic care. Leverage technology, use apps to answer questions, think smarter, use tele-medicine as a default instead of as a last resort. Guys, it is 2017 for Christ's sake. Quit acting like it is 1999.

There would need to be a sliding scale of what each individual will pay for basic care, based upon what their income is. This would be as easy to calculate as any other scale on the IRS web page. The more you make, the more you pay. The "slide" has to be a little regressive so that a $1 increase in wages does not equate to a $1 increase in health costs. Replace Medicaid with this sort of thing. Block-grant the states to manage it. Utilize HSAs (as I propose here) to pay for these things.

Once the baseline is established, then the rest of the discussion is merely funding and implementation. If the President can propose the premise and the Republicans lead with reasonable options, the Democrats would have to play along because it would be serving every American.

Both sides need to dial back the rhetoric. Democrats need to stop calling the rollback of taxes on investment income to pay for Obamacare as a "tax cut for the rich" and "giving money to millionaires" (by the way, it kicks in if your AGI for a couple is $250K). Republicans need to stop trying to defund Planned Parenthood as abhorrent as that group is. Allow folks to fund, as an option on their tax form, the funding of PP. Put their own money where their mouth is.

Lots of things can be negotiated but there has to be an agreed upon premise before the negotiations can start. President Trump knows this. The Republicans did not do that and they allowed the MSM and the Democrats to frame the narrative. This will never work and the Dems will always win the discussion if it is held in the three ring circus known as the media. It is time to work smarter, not harder.


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