I am not an expert at the ways of politics. Nor do I have access to actuarial material to know if this works. But in a few columns, I intend to lay out a health plan. This initial column tackles how we get people enrolled equitably.
First some assumptions.
- It needs to be single-payer. Anything other than that will leave too many exposed to cracks an crevices of not having insurance.
- Everyone needs to participate. If it does not have everyone, it will quickly devolve into an adverse selection program.
- There needs to be a mechanism by which low income individual and households are subsidized.
When you look at these basic assumptions, the only viable provider is the federal government. It pains me to say that, but it is true. Currently they are the only organization that has the ability to to reach everyone in both collecting premium and monitoring the subsidies.
Every working American is currently sending payment to the government throughout the year. The collection and processing infrastructure is already there. Its called the IRS and payroll deductions.
Yes there are people that are not currently employed, but if they are drawing unemployment, they should be filing a tax return. For those individuals that currently are not required to file a return? Start requiring one. A 1090EZ form takes less than 5 minutes.
Now we have everyone “enrolled” and those that have a means to pay are paying. That leaves only two things to work out
- What will be covered
- Subsidies for low income households
Admittedly when I say that, it is a clear over simplification. But the rest is administrative details. And while the devil is in the details, moving the conversation this direction as opposed to stops the posturing of politicians. When you strip away the ability to use “Health care is a right” or “Premiums keep rising” as talking points at your latest press conference and turn instead to the debate about pricing schedules for prescriptions or procedures, the rhetoric stops and the true work can begin.
We can also stop talking about the “individual mandate” and start calling it what it is, a tax. True, no one wants to pay more taxes, but we all think someone else should. Whether it is the liberals screaming the rich don’t pay their fair share, or the conservatives screaming the poor should pay something. Or the corporations should pay. Or we should do away with this deduction or that deduction. We all want “someone else” to pay.
Let’s agree though. Everyone should have access to basic health care and it is in our best interest to ensure that everyone, even those without financial means, do indeed have that access in a usable form. We have long ago accepted that providing a basic level of retirement security is something we will pay for. I believe the American people will do the same for health care. We just need to put politicians in office that would rather make that happen as opposed too many that view holding office as an opportunity to showcase to the world how bad the other side is.
As for the details, over the next few weeks, I will throw out some thoughts on those.
*I originally wrote this about a year ago, but never published it. That was long before anyone conceived that Donald Trump would be elected or that the Republican attempt at reform would flame out.