Monday, January 19, 2009

Universal Health Care

President Obama is going to be inaugurated tomorrow. This got me to thinking about one of his main campaign promises. Providing health care to all people in America. To begin with, I think the chances that he will succeed in implementing universal health care are about 20%. At best. The Clinton team sure failed miserably, but the Obama administration looks a good bit more competent than the Clintons.

Almost all of my life I have been fully covered. As a child the health insurance provided by my father’s employer was basically 100% of all essentials. All genuine health issues. I doubt that they would have covered breast implants or sex change operations, but if you were sick or injured you knew for sure that the health insurance would pay for the finest medical care available.

For roughly half of my working career the company I worked for paid 100% of the premium for our health insurance. And for the last half of my career I lived in Western Europe where universal health care is a reality. So I am familiar with the different ways that this concept can be implemented.

I believe in the KISS idea. Keep It Simple Stupid. So here in America one way to go about this would be as follows:

We already have universal health care for all people over the age of 65. To start out, one could simply say that anyone who does not already have employer provided health insurance is automatically covered by Medicare. Anyone. Everyone. If this system is good enough for our loved and respected old geezers then it should be good enough for everyone else too.

Of course almost immediately all companies would cease providing health insurance to their employees. That is fine, it will help make companies in America much more competitive with foreign firms operating in those countries which do have government provided universal health care.

Doctors, clinics, and hospitals will have to begin accepting these Medicare patients or they will rapidly go out of business, so there won’t be any need to make it mandatory. But it may be necessary to say to these health care providers that when they are treating a Medicare patient the provider will be compensated only by the government. So they will not be allowed to take some money for the government and then also try to extort additional money from the patients.

Some tweaking to Medicare will probably be necessary. Like having Medicare pay 100% of the cost of all medically necessary medications. Blood pressure medication, antibiotics, cancer medication, etc. Probably not Viagra though. Of course the government will need to bargain for the best pricing.

It could be that simple. What is not quite as simple is how are we going to pay for all this?

The alternative minimum income tax concept needs to be applied to all companies and people with high incomes. Maybe even non-profit foundations like all the rich like to set up. So regardless of the tax shelters or tax planning gimmicks that they employ, they still would have to pay a minimum amount of taxes. Just to pull a number out of the air, say, 30% of total income.

I suggest putting significant import taxes on everything coming into America unless the importer can prove that these items were produced in locations where the employees and their families received proper health care, and that the products were made in locations where environmental laws equivalent to those of America were enforced. The same goes for work place safety regulations, child labor laws, and minimum wage legislation.

These import duties will no doubt be so high on lots of things that many companies who have sent their production offshore will now find that it makes good business sense to go back to producing their products at home here in America.

Taxes on all motor fuels including diesel and gasoline need to be increased substantially. There need to be big federal sales taxes on low fuel economy vehicles. There should be a federal transaction tax for every time that a stock, bond, or derivative is sold. Fattening, unhealthy foods like soft drinks, beer, ice cream, candy, cookies, etc. need to have a large federal tax added to their final sale to the consumer. The same goes for most fast foods. Cigarette taxes need to go up again, at least $2- more per package.

If this doesn’t generate enough revenue, then the legislators should decriminalize recreational drugs like marijuana. Have the FDA control their quality and safety, and impose large taxes. Smoking regulated pot would still be cheaper than buying it illegally from drug dealers.

But like I say, there probably is less than a 20% chance that Obama will be able to implement universal health care. If he fails then it will be fair to say that this was just campaign speak/hype. Sort of like George Bush the First saying, “Read my lips, no new taxes.”

Does all this sound radical? Well, then listen to this. In America we pay higher taxes than the French. To make that statement be true just think of all health care expenses as taxes. In France health care is free.
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