The healthcare issue has been coming up a lot recently. The nomination of Kevin Zeese by the LPMD sparked a controversy over Zeese’s views on socialist healthcare. Tim West, over on Liberty For Sale, has the sad state of our healthcare system and offered some initial on it.
While I still hold my own ideals regarding healthcare, it’s becoming more and more obvious to me that the LP needs a coherent plan for healthcare that we can offer up in the short term, that’s more libertarian than the current system yet clearly addresses the worries of the uninsured.
Tim West had theto offer up on his own site:
We got a bill from the people that did my MRI scans on my brainium , of which there were 2 – one on 3/07, shortly after I woke up when I was still in ICU pre op, the other on 3/22 post op. It says I owe them $1667.40. I went and looked up online my claim information from my insurance company, which showed that both claims by the MRI company had been approved, and that my responsibility for each MRI was $167.40. :D Notice a extra “6” in the figure from the MRI place? They simply added a extra 6 and sent out the bill to me, even though my insurance had already approved and paid the bills. This is fraud.
This stuff is commonplace, and multiply this by about 30,000 a day, and you can see how screwed up one tiny aspect of our current system is. The reality is that every single bit player in the health care industry has set up a adversarial relationship with every other part. The doctors are always scared the patients are going to sue them, and frequently they do, because the legal system only works for the lawyers. The insurance companies are the middle men. Because they frequently dont pay all the bill, the providers jack up their cost sometime double of what they really are becuase they know that the insurance will then pay half that new amount. It’s a shell game. Medicare does this as well.
Some facts from my favorite source of facts, The Grandfathers Economic Report ( please note I have been given permission by Mr. Hodges to quote and use his material as long as a link is given and he is credited)
Note the U.S. spent 14.2% of its economy on healthcare at the date of this chart. The above update reports 2003 spending significantly higher, at 15.3% of GDP. Spending much more than nations covering all citizens via national health insurance.
April 15, 2005 — The New York Times (Paul Krugman): “In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child in the population. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending. Amazing, isn’t it? U.S. health care is so expensive that our government spends more on health care than the governments of other advanced countries, even though the private sector pays a far higher share of the bills than anywhere else.”
Some of this is misleading, because the taxes required to pay for the universal health care are higher than ours – but they cover ALL their people, and the difference is usually not that much. At my workplace, it costs an additional $400.00 a month to pay for a family policy. The costs go up about 8 to 9 % a year. So when you factor all that in, I’m not sure the “private” insurance companies are really providing cheaper health care, at least not to the extent everyone thinks they are. Would a government run system be better? Probably not. BUT THE SYSTEM WE HAVE NOW HAS ALL THE COST & PROBLEMS OF A SINGLE PAYER SYSTEM WITH NONE OF THE BENEFITS, SUCH AS COVERING EVERY PERSON. It’s just as complex, just as costly if not more so, and the only ones getting rich are the lawyers. That’s the reality of it – and libertarians lose credibility with voters when ideology trumps reality. The reality is our “private” health care system has around many of the problems of a government paid system with none of the benefits. What we have now is socialized medicine with insurance companies taking the place of government. It costs the company I work for a lot of money, and costs the employees a lot of money. I don’t really see what the difference is – either the insurance companies rape you or the government rapes you. Shouldn’t we care more about what will actually decrease the burden on the individual person rather than who’s on first?
I looked at those figures, and I did a little digging, and here’s a basic rough draft of an idea of mine that could please the socialists but still move America in a more libertarian direction with less government expenditures, lower taxes, yet enough coverage for everyone (Read on after the jump):
I think that the idea of national emergency procedure insurance isn’t a horrible one as far as socialism goes. Basically, everyone would be insured by the government for necessary procedures going over $1000 (or $2000, or $500, the line’s placement doesn’t so much matter so long as there IS a line). This plan would be free to everyone under 18 and over 70 or so, and to the disabled unable to work, and free to everyone else so long as they’re paying taxes (typically by working). Emergency insurance is nowhere near as costly as comprehensive insurance, and provides a solution to the worst problems inherent in the current system.
Everything else would be covered by the market, small injuries and checkups and the like. There’s no need for the government to pay for that, but it’s here, in the small stuff, that MSAs could play a huge role. The critics of MSAs argue that they would only help the rich, that the poor couldn’t put enough money into them to do any good. Well, if you only have to put a few thousand in in case you break a leg or something, it’s not that big of a problem, even if you’re poor.
Companies could also rework their medical benefits by putting, say, $1000 in their workers’ MSA every year or something. In fact, that would be preferable to the current system, because then it’s a fixed cost to the corporations instead of the current system. The current system, where employers offer health insurance to their workers, means that employers are an unnecessary third party and consequently end up paying more money than necessary for worker healthcare that’s not always necessary. Our tax system shouldn’t encourage the separation of consumer of goods and purchaser of goods. But if the companies put a fixed amount of cash in worker MSAs every year, they help provide for employee health while limiting costs much better and encouraging workers to be wiser consumers because that money is fully the worker’s now — he’s entitled to it whether he’s sick or whether he’s healthy. And since employer-funded MSAs don’t separate consumer and purchaser, I do think that companies should be able to deduct their MSA donations from their taxes.
Now, regarding Medicare and Medicaid: Medicare would be largely redundant, since the old and disabled would be automatically covered by the new system. The only gap left would be for small-scale healthcare (including medicine). There are about 30 million disabled people in America right now. We could organize their disabilities into categories of severity, where disabled people who can still work (the largest category) get $1000 of MSA money every year, the disabled who can work a little bit part-time get about $3000 of MSA money, and the fully disabled get $6,000 a year of MSA money. It sounds like a lot, but most of the 30 million disabled are also senior citizens. Since I’m not certain what the breakdown of disability categories is, we’ll assume as conservatively as possible and say that everyone’s fully disabled, in which case the cost is $180 billion to cover the disabled. (Really, it’d probably be like half of that.)
Senior citizens, on the other hand, are a different case. There’s 45 million senior citizens in the USA right now, and if we gave them $3000 a year of automatic free MSA money, that’d cost us $135 billion a year. Which is a huge sum, but less than the $260 billion we currently pay for Medicare and the $156 billion we pay for Medicaid. So instead of the $416 billion we pay annually to take care of senior citizens and the disabled, we’d be paying $336 billion (in reality, far less because we assumed high on the disabled). And we can trim that even more — not all seniors NEED this free money, in fact most of them don’t. Seniors would have to apply for MSA help, and would qualify on the basis of need. Basically, they’d have to have less than a certain amount in savings and MSAs, and have a regular need for an expensive drug. Looking at the amount of seniors under the poverty line, we see there’s only 3.3 million of them — so double that figure (again, being conservative) and if we only give THEM the senior MSA aid, it only costs $19.8 billion.
If we do this, Medicare and Medicaid can be scrapped, and that $416 billion a year that they consume would probably be under $150 billion a year instead. Not only that, but we could keep the amount of coverage at about the same level, and keep a free market in the principal segments of the healthcare industry. So long as this publicly-funded healthcare is privately delivered, the inefficiencies of socialism should only account for a fraction of a percent.
The only question left is the cost of the emergency healthcare insurance. It shouldn’t be terribly large — and it could be as large as $250-300 billion without costing us more than just the government-funded half of our current system, and that would work out to about the same cost as other industrialized countries with some sort of healthcare system in place.
Not a perfect system by any means, but I’d say that it would be better than the current one from a libertarian perspective and also from the perspective of the average voter. And, one day, after we’ve repealed taxes and regulations in the other parts of society that end up holding back the poor, elderly, disabled and the charities that help them, we can propose our ideal libertarian solution without having it sound unrealistic.
Thoughts? Clearly we can’t realistically keep advocating a fully privatized system as a practical solution for the short-term, so this moves us to the place where we can, say, twenty years from now.