A realistic health care solution

January 19, 2008|By ROBERT GARY

Whatever national health care system is created will have to exist within two fundamental limits: The scarcity of money and the scarcity of health-care providers. We don't want hyper-inflation, so we can't just print money to pay for the program. The really best talent in any field is, by definition, rare, so there is scarcity of the top surgeons, just as there's a scarcity of the best engineers, or the best computer programmers.

First, quality health care is always going to be a scarce service and there's nothing that our government can do about that. What a good national health care system can do is function within these limits in a rational and effective way. Since that's what's possible, here are guidelines.

1. The system has to be 100 percent voluntary - nobody has to have anything to do with it if they don't want to. All arrangements that people have now - insurance-wise and doctor-wise - can stay exactly as they are.


2. Since we are a national community, people within our national community should be the beneficiaries of a national health care system - as distinct from anyone who happens to walk across a border and be hanging around in the waiting room at the hospital.

Why does a community take care of its own members instead of taking care of all mankind? Well, it's not a church, or a charitable foundation. It owes a duty to its contributors (taxpayers, military veterans, and others who perform national service and official community service) to use their contributions for their benefit. Churches and charitable foundations have no such duty. They can use any or all of their assets for the benefit of anyone they choose and many do.

3. Since there is generally a scarcity of top-notch medical talent, there would be a corresponding scarcity within a national health care system. For the people within the national system, money does not determine the services provided - patients don't have to compete with each other on a cash basis to get medical services. But treating everybody exactly the same is not rational; some people have made a greater contribution to the national community than others.

4. My prioritization list is a personal perspective. Honorably discharged military veterans, national civil service and community health care and police and fire services providers and retirees from such activities would come at the top. After them, Congress people, judges, Executive Branch officeholders or former appointees, based on their length of service. After them, persons who have legally worked 40 quarters in the U.S. After them, all other U.S. citizens who have paid their premiums and joined the National Health Care Plan, the only distinction among them being their degree of need for immediate care.

Hospitals would still be obligated to provide emergency care to U.S. citizens who have chosen not to join the National Health Care Plan, or who have not paid their premiums, (and where no federal, state, or charitable, organization has paid premiums on their behalf), and also emergency cases among legal aliens, and finally, emergency cases among illegal aliens. But this would have to be done outside our national health care system.

Any proposed national health care system that is mandatory on a universal basis is self-defeating because the American people will rise up against it.

Any system that is voluntary, such the one outlined here, is going to have some people who still fall through all the cracks. Right now, 43 million people have no health insurance. A voluntary program that reduced that number by 90 percent, to about 4.3 million people nationwide, would be very good.

The perfect is the enemy of the good. National health care needs to be run like a business or it will become a money pit and drag down our national solvency. Since this proposed system is 100 percent voluntary and since most Americans in the high-rate groups would stick with what they already have, most patients in the waiting room would usually get fairly equal treatment.

5. Every signed-up premium-paying member gets a card. Thus, we can estimate our costs and experience-rate our premiums. What you rate is measured by your personal contribution to our national community. For example, a retired firefighter with 20 years of service putting out fires, would get priority over a person with a violent criminal record who has been a drug dealer since childhood.

What a person rates should, in my view, depend broadly on what that particular individual has done for our national community. Public policies are a compendium of personal views, and when these come to unity, a community emerges. We need to build a community for national health care.

Robert Gary is a Hagerstown resident who writes for The Herald-Mail.

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