The current
health care �debate� shows how
far gone representative government is in the United States. Members of Congress
represent the powerful interest groups that fill
their campaign coffers, not the people who vote for them.
The health
care bill is not about health care. It is about protecting and increasing the
profits of the insurance companies. The main feature of the health care bill is
the �individual mandate,� which
requires everyone in America to buy health insurance. Senate Finance Committee
chairman Max Baucus (D-Mont), a recipient of millions in contributions over his career from the insurance
industry, proposes to impose up to a $3,800 fine on Americans who fail to
purchase health insurance.
The
determination of �our� elected
representatives to serve the insurance industry is so compelling that Congress
is incapable of recognizing the absurdity of these proposals.
The reason
there is a health care crisis in the US is that the cumulative loss of jobs and
benefits has swollen the uninsured to approximately 50 million Americans. They
cannot afford health insurance any more than employers can afford to provide
it.
It is
absurd to mandate that people purchase what they cannot afford and to fine them
for failing to do so. A person who cannot pay a health insurance premium cannot
pay the fine.
These
proposals are like solving the homeless problem by requiring the homeless to
purchase a house.
In his speech, Obama said �we�ll
provide tax credits�
for �those individuals and small
businesses who still can�t afford the lower-priced insurance available in the
exchange� and he said low-cost coverage will be offered to those with
preexisting medical conditions. A tax credit is useless to those without income
unless the credit is refundable, and subsidized coverage doesn�t do much for
those millions of Americans with no jobs.
Baucus
masquerades as a defender of the health impaired with his proposal to require
insurers to provide coverage to all comers as if the problem of health care can
be reduced to pre-existing conditions and cancelled policies. It was left to
Rep. Dennis Kucinich to point out that the health care bill ponies up 30
million more customers for the private insurance companies.
The private
sector is no longer the answer, because the income levels of the vast majority
of Americans are insufficient to bear the cost of health insurance today. To
provide some perspective, the monthly premium for a 60-year old female
for a group policy (employer-provided) with Blue Cross Blue Shield in Florida
is about $1,200. That comes to $14,400 per year. Only employees in high
productivity jobs that can provide both a livable salary and health care can
expect to have employer-provided coverage. If a 60-year old female has to buy a
non-group policy as an individual, the premium would be even higher. How, for
example, is a Wal-Mart shelf stocker or checkout
clerk going to be
able to pay a private insurance premium?
Even the
present public option -- Medicare -- is very expensive to those covered. Basic
Medicare is insufficient coverage. Part B has been added, for which about $100
per month is deducted from the covered person�s Social Security check. If the
person is still earning or has other retirement income, an �income-related monthly adjustment� is
also deducted as part of the Part B premium. And if the person is still
working, his earnings are subject to the 2.9 percent Medicare tax.
Even with
Part B, Medicare coverage is still insufficient except for the healthy. For
many people, additional coverage from private supplementary policies, such as
the ones sold by AARP, is necessary. These premiums can be as much as $277 per
month. Deductibles remain and prescriptions are only 50% covered. If the drug
prescription policy is chosen, the premium is higher.
This leaves
a retired person on Medicare who has no other retirement income of significance
paying as much as $4,500 per year in premiums in order to create coverage under
Medicare that still leaves half of his prescription medicines out-of-pocket.
Considering the cost of some prescription medicines, a Medicare-covered person
with Part B and a supplementary policy can still face bankruptcy.
Therefore,
everyone should take note that a �public
option� can leave people with large out-of-pocket costs. I know a
professional who has chosen to continue working beyond retirement age. His
Medicare coverage with supplemental coverage, Medicare tax, and income-related
monthly adjustment comes to $16,400 per year. Those people who want to deny
Medicare to the rich will cost the system a lot of money.
What the US
needs is a single-payer not-for-profit health system that pays doctors and
nurses sufficiently that they will undertake the arduous training and accept
the stress and risks of dealing with illness and diseases.
A private
health care system worked in the days before expensive medical technology,
malpractice suits, high costs of bureaucracy associated with third-party payers
and heavy investment in combating fraud, and pressure on insurance companies
from Wall Street to improve �shareholder
returns.�
Despite the
rise in premiums, payments to health care providers, such as doctors, appear to
be falling along with coverage to policyholders. The system is no longer
functional and no longer makes sense. Health care has become an incidental
rather than primary purpose of the health care system. Health care plays second
fiddle to insurance company profits and salaries to bureaucrats engaged in
fraud prevention and discovery. There is no point in denying coverage to
one-sixth of the population in the name of saving a nonexistent private, free
market health care system.
The only
way to reduce the cost of health care is to take the profit and paperwork out
of health care.
Nothing
humans design will be perfect. However, Congress is making it clear to the
public that the wrong issues are front and center, such as the belief of Rep.
Joe Wilson (R-SC) and others that illegal aliens and abortions will be covered
if government pays the bill.
Debate
focuses on subsidiary issues, because Congress no longer writes the bills it
passes. As Theodore Lowi made clear in his book, The
End of Liberalism, the New Deal transferred lawmaking from the
legislative to the executive branch. Executive branch agencies and departments
write bills that they want and hand them off to sponsors in the House and
Senate. Powerful interest groups took up the same practice.
The
interest groups that finance political campaigns expect their bills to be
sponsored and passed.
Thus: a
health care reform bill based on forcing people to purchase private health
insurance and fining them if they do not.
When bills
become mired in ideological conflict, as has happened to the health care bill,
something usually passes nevertheless. The president, his PR team, and members
of Congress want a health care bill on their resume and to be able to claim
that they passed a health care bill, regardless of whether it provides any
health care.
The cost of
adding public expenditures for health care to a budget drowning in red ink from
wars, bank bailouts, and stimulus packages means that the most likely outcome
of a health care bill will benefit insurance companies and use mandated private
coverage to save public money by curtailing Medicare and Medicaid.
The
public�s interest is not considered to be the important determinant. The
politicians have to please the insurance companies and reduce health care
expenditures in order to save money for another decade or two of war in the
Middle East.
The
telltale part of Obama�s speech was the applause in response to his pledge that
�I will not sign a plan that adds one
dime to our deficits.� Yet, Obama and his fellow politicians have no
hesitation to add trillions of dollars to the deficit in order to fund wars.
The profits
of military/security companies are partly recycled into campaign contributions.
To cut war spending in order to finance a public health care system would cost
politicians campaign contributions from both the insurance industry and the
military/security industry.
Politicians
are not going to allow that to happen.
It was the
war in Afghanistan, not health care, that President
Obama declared to be a �necessity.�
Paul
Craig Roberts [email
him] was Assistant Secretary of the Treasury during President
Reagan�s first term. He was Associate Editor of the Wall Street Journal. He has
held numerous academic appointments, including the William E. Simon Chair,
Center for Strategic and International Studies, Georgetown University,
and Senior Research Fellow, Hoover Institution, Stanford University. He was
awarded the Legion of Honor by French President Francois Mitterrand. He is the
author of Supply-Side
Revolution : An Insider�s Account of Policymaking in Washington; Alienation
and the Soviet Economy and Meltdown:
Inside the Soviet Economy, and is the co-author with Lawrence M.
Stratton of The
Tyranny of Good Intentions : How Prosecutors and Bureaucrats Are Trampling the
Constitution in the Name of Justice. Click here for
Peter Brimelow�s Forbes Magazine interview with Roberts about the recent
epidemic of prosecutorial misconduct.