Tuesday, September 8, 2009

IHCA and the 800-pound Gorilla in the room...

Let me begin by saying if you intend to propose some kind of self-directed 'savings account' mechanism to assist with providing long-term tax-advantaged financing for your (eventual) personal Health Care needs, I whole-heartedly agree. I support the concept in the same way I like IRA accounts (especially the Roth variation). For Health care, we already have a form of this option in HSA (Health Savings Accounts) and MSA (Medical Savings Accounts). For some reason these options are not strongly promoted, and they apparently have a 'sunset provision' which limits long-term access to the program. (One wonders if they are too simple and too effective to be allowed to continue.)

However, I am guessing you will suggest having the 'contributions' to these personal accounts being initiated by direct government payments (with a possible option for additional voluntary contributions). That sort of public financing takes away from the 'take personal responsibility for yourself' that I try to encourage. *BUT* I could support such a government 'contribution' of largess from the taxpayers *IF* it is applied EQUALLY to *all* citizens. That means Joe SixPack and Bill Gates *both* get the exact same contribution to their respective self-directed accounts. (This is similar both in concept and in principle to the monthly "pre-bate" to compensate for for sales taxes on basic necessities within of the FairTax - another good idea, but that is a discussion for another day.)

I consider this aspect of Equal Public funding as critically necessary because of a long-ignored concept called "Equal In The Eyes Of The Law". Following it also eliminates the need for a bureaucracy devoted to deciding "Who Qualifies" (which both reduces cost and possibilities for potential abuse). I submit this 'pre-existing condition' (pun intended) for public funding for your consideration as I eagerly await further details of your proposal...

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Also, I really appreciate the effort you have put into researching where, when and how much we are spending. Your recognition that our society and culture doesn't really allow following the path and approaches adopted by other countries is gratefully acknowledged. (Loud Cheers!) The inherent mechanisms of our captialism-based system has generated a quality of care and treatment options which are unmatched in the world.

Even better, our program (LRA&H) is still in development. It doesn't hurt to learn from the mistakes (and success) of others, but we should continue to move with caution since we are rebuilding from the ground up apx. 1/6th of our economy. As such, we should not expend much effort attempting to modify ('fix') existing programs which have already failed, usually due to administrative overhead as much as anything. The "let's *really* start over" tactic, as we have stated our intent, is the proper approach.

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*However*... I do not recall a response to my point: If we are doing all this 'restructuring' to make sure Health Care is available for those who need it... why can we not simply increase or implement government programs to PROVIDE that care? The focus of most (all?) proposals has at their core some aspect of providing (financing) INSURANCE coverage... IMHO, that is putting the cart before the horse by only being concerned solely with how to distribute the Cost of Health Care, not on what it takes to Provide it.

That is why I propose we remove as many government (including both federal and state-level) conditions and regulations which get in the way of allowing competition in the marketplace. If the government becomes another provider - for those who choose it - and there are options allowing private concerns to shift non-critical care burdens to that program as needed, then everyone wins. Private remains private, the much ballyhooed 'public options' exist as a separate entity, but are not mandatory, and individuals can make their own decisions and reap the consequences thereof. Win-Win.

I also suggest that the eventual cost savings (if such things actually existed) would be much greater if the focus was not on getting one's hands filled by a direct transfer of payment from the public trough.

And if you don't like the quality of service or available treatments or waiting in line or other objectionable realities in the public option? You can go get what you desire / want / need / gotta-have in the private sector (at it's free market price)...

Just because you have a desire (or even a need) for a particular level of service or access to a specific product - according to YOUR judgment - does not mean you are entitled to use the force of government to TAKE IT from someone else at the point of a gun: TANSTAAFL!

Likewise, we must directly and carefully address the SUPPLY side of the equation, not just the DEMAND side. "The demand for a free good or service is infinite." (That horse should be dead by now, but as long as it moves, I'll keep shooting at it.) If we don't address the staffing requirements for providing services, we will FAIL. Having the government HIRE and encourage the creation of *new* trained staff is critical. Simply working out an alternative payment plan is ineffective in the long run.

We agree that whatever system we devise *must* be aware of BOTH the Goods and Services to be provided, and how access to those programs are likely to be USED. That means considering the application of check-and-balances as well as severe penalties for mis-use of the system.

Much of this is merely restating both the obvious and issues you have already acknowledged. We have a long way to go. So - Keep at it, my friend! We're making progress, slowly but surely...

- Steve

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