Should we, as a society, provide health care for all?  I believe the answer is a resounding “YES!”  Can we?  Again, I believe the answer is a resounding “YES!”  The following proposal would provide exemplary coverage for all Americans – in most cases far better coverage than they have now – without adding to the deficit.  It would remove the profit motive from medical decisions, but would not displace a single American business.  It would provide oversight but preserve the competition inherent in a free market.  It would mandate coverage for all, but offer flexibility.


Interested?  Read on…


Reforming the health care system to provide access for all has become something of the “holy grail” of political reformists on both sides of the issue.  President Clinton, apparently feeling he was too busy to do it himself, assigned the task to his First Lady (a totally unprecedented move that only served to confirm the worst fears of the neocons).  The plan Hillary Clinton and her committee developed was a convoluted, incredibly complex system that attempted to please everybody, but wound up pleasing nobody.  After the requisite hearings and deliberations, it was soundly rejected.  Since then, no serious attempt has been made to overhaul the nation’s health care system, with the exception of the Medicare Reform package (including the new prescription drug benefit) that President George W. Bush signed in his first term.  It hasn’t exactly been the panacea it was thought to be, and cost forecasts have already doubled.



Profit Motive


There is a serious inconsistency inherent in our current system.  This inconsistency can be found in perhaps the most basic tenet of business:  corporations don’t exist for altruistic reasons, corporations exist to make money.  They have a duty to their investors to show a profit.  It is with this duty in mind that business decisions are made, and corporations therefore make decisions that will reduce their costs and increase their revenues.  When it comes to providing health care, this is a recipe for disaster.  Entrusting the health care of America to the private sector – in other words, allowing profit motive to intrude on decisions regarding patient care – has led to a series of seemingly insurmountable problems.


A good example of these insurmountable problems is the health insurance industry.  The best way for a health insurance company to reduce costs is to not provide health care!  This has led to coverage being denied for needed tests and procedures, people denied any coverage at all due to “pre-existing conditions”, and catastrophic and long term care – the cause of approximately 75% of all bankruptcies in the United States – not being included in most health care plans.  In one particularly egregious example (exposed by the Los Angeles Times), individual Health Net employees were actually given bonuses for canceling coverage for their customers who became sick!  On the other side of the equation, the best way for a health insurance company to increase revenue is to increase premiums.  Spiraling health insurance costs have driven many employers who offer health benefits to their employees to cancel those benefits, lay off workers, and/or ask those that remain to pay a higher share of the cost of those benefits, leaving the employees with less discretionary income they can use to invest, make purchases, and so on.  These spiraling health care costs also affect the ability of every business that provides health care benefits to their employees to make a profit, and most pass the added costs on to us, the consumers who, because we now are paying a larger share of our own health care benefits, have less spending money to begin with.  The impact on the overall economy is widespread and profound.  The end result is heath insurance companies providing lower and lower levels of coverage for higher and higher premiums.  This is simply not sustainable. Worse yet, about 47 million Americans do not have health care coverage at all.  This is roughly 16% of the American people – or about 1 in every 6 Americans – and these Americans are forced to wait until a minor health problem develops into a crisis, so they can then go to an over-crowded emergency room where the cost of treating the crisis – a cost for which the hospital is often not reimbursed – will far exceed the cost of an earlier intervention.  The increased premiums have also hit the doctors themselves; as a result of out-of-control jury awards to patients in malpractice lawsuits, malpractice insurance premiums have skyrocketed. This has made it more and more difficult for doctors to make a profit on their own, which forces more doctors to work for large clinics and medical groups, consolidating the health care system and entrusting the health care of Americans to ever-fewer and ever-larger corporations.  Tort reform (probably including a cap on potential jury awards) and reform of the health insurance industry will be essential to the success of any new system.


Pharmaceutical companies spend large amounts of money on research and development of new medicines – a critical function that must be maintained in whatever form of health care system is eventually adopted – but these companies then patent the new medicines and charge exorbitant prices.  Why?  Because they can!  Simply put, these companies know our system and know we will pay whatever price they charge (the new Medicare prescription drug benefit law, for example, explicitly forbids Medicare from negotiating lower prices, something that the VA is allowed to do).  As further evidence of the price gouging on the part of the pharmaceutical companies, the cost of any given medication in Canada is significantly lower than it is for the same medication – produced by the same company – in the United States.  The issue of importing medications from Canada has been intensely opposed by the pharmaceutical industry and by many of the lawmakers to whom these companies give campaign contributions. Bringing the cost of prescription drugs under control – while still providing the pharmaceutical companies enough profit to encourage research and development – will have to be part of any new health care system.


Undocumented Immigrants


An additional complication is the issue of undocumented immigrants receiving health care services.  Should the new system – whatever form it may take – require proof of citizenship or legal residence in order to receive health care services?  If we deny health care services based on immigration status, will undocumented immigrants who don’t have access to health care become a source of epidemics that spread across America because these people were unable to receive treatment when they first got sick?  If the new system does not require such proof, how will we pay for providing these services?  What if someone is brought into a hospital unconscious and does not have such proof with them?  What about a life-or-death emergency situation?  What about an emergency situation that does not involve a life-or-death urgency (broken bones, serious contagious illness, etc.)?  What about a pregnant woman in labor?  We obviously can’t tell her to not to give birth, and if she’s already in labor, then realistically there is no time to deport her before she gives birth.  The child will be born in the United States.  Will the newborn child, born in the United States but with parents who are undocumented immigrants, still be a United States Citizen (as they are now under the 14th Amendment to the Constitution of the United States, which reads, “All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the states wherein they reside.”), or should the new health care reform package include a Constitutional Amendment redefining citizenship to exclude children born to undocumented immigrants (as would be necessary to deny the newborn child United States citizenship)?  If we don’t amend the Constitution (which is a difficult task, to say the least) to deny such a child United States citizenship, what do we do with the parents?  Do we allow them to remain in the United States now that they have a child who is a United States citizen (which could lead to undocumented immigrants having children for the sole purpose of being allowed to stay here), or do we deport them?  If we deport the parents, do we deport the child as well, or do we tear the family apart?  The child is a United States citizen who is innocent of any crime or infraction.  The Constitution prohibits “corruption of blood”, or punishing a child for a crime committed by a parent (actually, the Constitution only prohibits this in relation to treason, but the concept has traditionally been applied to all crimes), and clearly states – twice – that no person shall be deprived of life, liberty or property without due process of law.  How can we deport a United States citizen who is innocent of any crime or infraction and therefore has not received “due process of law”?  Are we really willing to punish a child for the actions of their parents? These questions will have to be addressed one way or the other, inextricably linking any prospect for successful health care reform to the issue of comprehensive immigration reform.



Previous Proposals


There has been much in the way of talk about health care reform, but very little in the way of action.  President Clinton’s plan, as stated above, was far too convoluted to work, or even to have a chance of passing.  In general, President Bush’s approach has been to attempt to work through the existing private sector.  The downside of this approach is that it simply doesn’t work – it is essentially just more of what we have now.  The most appealing proposal from President Bush has been the concept of tax-free “health savings accounts” that people could use to pay insurance premiums or cover health care expenses, but while this could be a step in the right direction, it falls far short of the goal of health care for all.  During the 2008 Presidential campaign, several candidates offered health care reform proposals, including “top-tier” Democrats Hillary Clinton (very different from her 1993 proposal), John Edwards, and Barack Obama, but not one of these plans would have covered all Americans (despite the claims of the candidates).  On the Republican side, John McCain, Rudy Giuliani and Fred Thompson all offered plans which, according to the Los Angeles Times, wouldn’t even have covered themselves (all three are cancer survivors, and would therefore be excluded from their own plans)!  Mitt Romney pushed for and signed the most comprehensive health coverage plan in the country as Governor of Massachusetts, but proposed something very different – and far less comprehensive – as a national plan.  Only Mike Gravel and Dennis Kucinich (neither of whom had even a remote chance of winning) offered a plan for truly universal health coverage.  In 2004, John Kerry, noting that the American taxpayers provide United States Senators and Members of Congress (and their families) with the best health care coverage money can buy, proposed making access to that same health care coverage available to all Americans – not a bad idea – but he did not specify how he would have accomplished this – or paid for it.  The 2007 Michael Moore documentary “Sicko”, an indictment of our health care system, was well received and did a good job of presenting many of the issues involved, but frankly, nothing put forward by Michael Moore is going to be taken seriously by Republicans (or even some moderate Democrats).  Moore’s film also made the case for a single-payer Canadian-style national health plan, which has little or no realistic chance of getting through the Congress – at least not in the form Moore proposed – and would not, in my opinion, be the best solution for America.


“Socialized Medicine?”


Any time any sort of government-paid health care system is proposed, opponents cry “Socialized Medicine!”  But just what exactly do they mean by “socialized”?


In a nutshell, a service is “socialized” when that service is provided by the government equally to all and funded by the taxes we all pay.  That’s it – nothing more. While the term “socialized” brings to mind “socialism” and “communism” (and is thus used intentionally as a rallying cry by those who oppose such a system), it is actually neither.  “Socialized” services have been part of our American way of life at all levels of government – federal, state, and local – from the founding of our nation.


Need examples?  How about national defense, social security, public education, police and fire protection, public libraries, local parks, the National Park system, highway maintenance, consumer protection services, putting on state-wide elections, and so on.


It seems that just about any service the government provides, then, is a “socialized” service, right?  Well, yes and no.  Some services are available only to a given sector of the population, such as social security and Medicare, and others charge fees for accessing them, such as higher education and the National Parks.  (It is important to note that these fees do not even come close to actually paying the cost of providing the service.  One exception is the United States Postal Service; the Post Office has been “off-budget” – meaning entirely self-sufficient for its funding – since 1983.).  But many services, among them education and emergency services such as police and fire protection, are in fact provided on a “socialized” basis.


So if we already have “socialized” education, “socialized” police and fire protection, and the rest, what would be so bad about “socialized” medicine?  The truth is, we actually have “socialized medicine” in three different forms already – and we have had them for decades!   The first, and most “socialized” form, is what exists in the VA Hospital system.  At the VA, the equipment, the buildings, and even the land it all sits on are owned by the federal government (meaning the taxpayers).  All staff, from the custodian to the most specialized surgeon, are federal employees. Any veteran can receive all of their medical care through the VA at no cost.  This is truly “socialized medicine”!  Like the VA, the military has its own hospitals, but routine care for active military and their families is provided through the second form of “socialized medicine”, where a private health insurance company (called “Tri-Care”) provides the coverage, but the insurance premiums are paid by the federal government. Another group that has its insurance premiums paid by the taxpayers – and therefore enjoys the benefits of this second form of “socialized medicine” – is federal employees, because (like any employer may do) the federal government provides health care to its employees.  Finally, the third form of “socialized medicine” can be seen in programs like Medicare, Medicaid, and SCHIP, where the federal government itself acts as the health insurance company, paying doctors and other providers – just as a private health insurance company would – for medical services provided to their customers.


If “socialized medicine” is okay for these groups, why not for the rest of us?


The main problem is that health care is big – and I mean BIG – business.  In the other areas (education, police and fire protection, etc.), the service has always been “socialized”, and no businesses stand to be displaced by the “socialization”.  Besides, services like education, police and fire protection, and the rest are politically untouchable – no politician in their right mind (with the possible exception of Ron Paul) would suggest eliminating them completely as a government service and entrusting them entirely to the private sector.  You’ll never hear a neocon rail against “Socialized Education!” when proposing vouchers. In health care, however, huge corporations (that give correspondingly huge political donations) stand to lose everything if the United States goes to a government-paid Canadian-style health care system.  The fear is that any such system would be horrendously inefficient, with long delays and poor quality of care, that it would set prices too low for medical services; discourage research and development by providing a lower financial reward as an incentive; eliminate health insurance companies (along with the jobs and investment capital that go with them), and severely reduce the profits of the pharmaceutical companies, with set prices for the medications they develop.


Taken to its extreme, “socializing” health care (according to those who oppose it) would start our nation down a “slippery slope” leading to the tendency to “socialize” more and more services, eventually leading to a soviet-style system, where everything from the bread we eat to the movies we watch would be produced by the government.  On the other hand, these same opponents tend to want to privatize all services, from education (with vouchers) to social security savings.  It could be argued with equal validity that taken to its extreme, privatization of these services would start us down a similar “slippery slope”, yielding results just as undesirable as the tendency to “socialize” services:  privatized national defense would lead to a system of warlords like that which exists in Afghanistan; privatized fire protection would lead to people going through the phone book trying to decide which private fire fighting company would provide the best service at the lowest cost – all while the house is burning!  Both extremes are clearly farcical, and the American people will know where to draw the line.


The Role of Government


So should we “socialize” health care?  To answer that, we need to ask ourselves what we believe the appropriate role of government to be.  We need look no further than the political philosophy articulated in our nation’s founding documents.  Our nation is founded on the principle, expressed so eloquently by Thomas Jefferson in the Declaration of Independence, that all Americans are “endowed by their creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness [and] that to secure these rights, governments are instituted among men…”  Jefferson later wrote that “Health is the first requisite after morality.”  President John F. Kennedy said that “Good health is a prerequisite to the enjoyment of the pursuit of happiness”.  Clearly, no one can live life engaged in “the pursuit of happiness” if they are not in good health and what President Kennedy described as “the miracles of modern medicine” are not available to them.


In another of our fundamental founding documents, the Preamble to the Constitution of the United States, our founders listed “to promote the general welfare” as one of six appropriate purposes for establishing our nation’s government.  Many Americans mistakenly believe that we have the world’s best health care system.  The truth, however, is that when compared to other industrialized countries that provide national health care plans, our life expectancy is lower, our rates of diabetes, cancer, hypertension, heart disease, obesity and other major health problems are higher, our recovery rates from such health problems are lower, and our infant mortality rates are higher.  While many of these other countries have experienced serious problems related to their health care systems, I believe we can achieve the goal of health care for all without importing those problems here.  In addition to the poor health statistics, the economic statistics also indicate that we must do better than we are doing now.  Currently, despite the fact that we spend more money per capita on health care than any other nation on earth, almost three out of every four personal bankruptcies in the United States are the result of health care expenses, and over half of these families had health insurance at the time.  Increased labor strife, reduced purchasing power and the resulting drag on our national economy, and the closing of emergency hospitals, medical centers and trauma centers across the country (the result of medical treatments these facilities are required to provide to the uninsured – usually without reimbursement) are all the result of our broken health care system.  The economic impact of spiraling health care costs are so widespread and profound as to render them virtually incalculable, and will only get worse if we don’t do something to bring these costs under control.  Obviously, providing health care for all would “promote the general welfare”.


I believe it is appropriate for government to establish a society in which basic human needs – including access to health care – are accessible.  Is health care any less of a basic human need than education, police protection, or fire protection?  How about public libraries?  City parks?  All of these government services are “socialized” in the same sense that has outraged the opponents of a national health care system.  Are they suggesting that city parks are more of a basic human need than access to health care?  In my view, the question is not whether the government should have a role in providing access to health care – it clearly should – the question is what form the government’s role should take.  If we still believe in the principles upon which our nation was founded, then we have to concede the point that providing health care has become an appropriate role for government in the modern era.


What Should Reform Look Like?


The reality is that the health care delivery system in America is badly broken, and reform is inevitable; the problem is that we can’t seem to agree on how to fix it.  Many have pointed out that the United States is the only industrialized nation in the world that does not provide universal health care.  We must be careful not to jump in without first “testing the waters”, however.  Nations that have such national health care plans are having serious problems, including misplaced priorities in terms of needed care leading to outrageously long waits for treatment (in some countries, for example, “psychological need” – which could include a “tummy tuck”, face lift, or sex-change operation – is put on an equal par with “medical need”, and can actually be ahead in line), poor quality of care, and countries driven to the brink of national bankruptcy.  We obviously don’t want to bring those problems here.  While we don’t want to simply copy some other country’s plan, however, we should try to learn from their mistakes – and their successes.  If some aspect of another country’s system works well, we should consider incorporating that aspect into our new plan.  We need to keep in mind that there are also aspects of our own current system that work well, and these aspects should be preserved in any new system.


Simply put, what is needed is a uniquely American plan, based on certain philosophical beliefs:  1) providing health care for all is not just an appropriate role for government, it is a necessary role and we should settle for nothing less; 2) medical decisions should be made by medical professionals in consultation with their patients, not by accountants concerned with profit margins; 3) each generation – including ours – should pay the costs of providing its own health care, rather than forwarding those costs to future generations; and 4) a hybrid system that combines the best aspects of both the public and the private sectors would avoid the potential pitfalls inherent in relying exclusively on either sector.  There are several clear criteria that must be met by whatever system is eventually put into place.  The new system must


  • Be affordable – for individuals and businesses, and at the national level.
  • Provide full and equal access to exemplary health care for all Americans – period.
  • Provide for timely treatment of patients, based on actual medical need.
  • Base medical decisions on the medical needs of the patient, rather than on the profit margin of a given company.
  • Provide an unbiased system for appealing adverse coverage decisions.
  • Provide a system for appropriate oversight of health care providers that is responsive to consumer complaints, yet protects health care providers from frivolous and/or fraudulent claims.
  • Provide prescription medications at minimal cost to the consumer, but adequate reimbursement to the manufacturer.
  • Provide for adequate incentives to ensure that America continues to lead the world in research and development of new medical technologies, medications, and innovations.
  • Control malpractice insurance premiums at a reasonable level that won’t put health care providers out of business, while still ensuring payouts on legitimate malpractice claims that adequately compensate the victims of actual malpractice.
  • Displace the fewest possible number of businesses currently involved in providing health care and the many related services.
  • Address the issue of undocumented immigrants as that issue relates to health care services.


The new system will have to meet all of the above criteria – and then some.  And then some more.  In short, the American people deserve – and should settle for – nothing less than the world’s best health care system.  It will be no easy task, but the challenge must be confronted – now.  Health care in America has developed into a full-blown crisis, holding back our economy and becoming a leading issue in virtually every labor dispute for the last several years.


I believe that we can do this, but people are angry.  Those working Americans lucky enough to have health care benefits are being asked to pay ever-higher portions of their coverage premiums, along with co-payments for office visits, treatments, and medications, without a corresponding increase in pay, and all for an ever-lower quality of care, while the health care industry – at least in the popular perception – reaps huge profits.  Until this issue is addressed and real reform is accomplished – until someone demonstrates actual leadership on this issue – people will only get angrier.  While the various proposals put forth by the 2008 Presidential candidates were promising, no plan offered by a candidate with any chance of winning would have reached the ultimate goal – the “holy grail”, so to speak – of full coverage for all.  At the very least, however, these proposals have moved the issue to the front burner on the national stage, where it belongs, and President Obama is pursuing Health Care reform as one of his top priorities.



Dave’s Proposal


I would propose a system that mandates coverage for all Americans.  We currently require all Americans to register for social security; we could do the same with health care.  Under this plan, the American people would be required to select a health insurance plan for themselves and their children from a list of government-certified plans offered by health insurance companies – and the health insurance companies would be required to accept any American who selected their plan.  There would be no exceptions for anything like age, pre-existing condition, disability, or anything else.  There would be no “National Identification Card” or “Health Security Card”; each individual would simply receive a health insurance card from the selected health insurance company, just as they do now.  In order to become certified and be included on the list from which the people could choose, these plans would be required to include a minimum set of comprehensive benefits, patterned after the exemplary coverage currently provided by the taxpayers to United States Senators and Members of Congress.  Practitioners would be required to accept any certified plan, meaning that all Americans could go to any doctor they choose – including specialists.  For each individual American that chooses a given plan, the government would pay a set premium to the insurance company whose plan is selected, a premium that would be the same amount regardless of which certified plan was chosen.  There would be an option to “opt-out” of the system, but only for those who can verify that they have their own coverage (either by paying for it themselves or having it provided by their employers as an employment benefit).  Guidelines would be created that provided for stiff penalties – from criminal liability and fines to rescinding certification – against insurance companies that denied coverage to which their patients were entitled under their certified plan.  If any individual so desired, they could add additional benefits to their selected certified plan by paying the premiums for these benefits themselves, but they could use money set aside in new tax-free “Health Savings Accounts” to pay these premiums.  These additional benefits would be provided by the same insurance company that provides the selected certified plan; what additional coverage options a given company offers – and at what cost – would be a key factor in the selection of a certified plan in the first place.  Competition among the insurance companies would continue to exist in the range and prices of additional coverage options, and in the form of improved customer service (along with the stiff penalties for denying coverage, the people could switch plans at any time, meaning the insurance companies would actually have a financial incentive to provide coverage!).  If the competition became intense enough, the insurance companies could even add coverage options that exceed the minimum set of benefits at no extra cost (or reduced cost) to the consumer, in order to attract more Americans to their plan.


In addition, this proposal would include:

  • Tort Reform:  This proposal would impose limitations on health care-related lawsuits, caps on potential awards in malpractice lawsuits and on malpractice insurance premiums, and provide for severe penalties for fraudulent or frivolous malpractice claims.
  • Leveraged Negotiation of Pharmaceutical Prices:  This proposal would allow the government to use its purchasing leverage to negotiate lower prices on pharmaceuticals (as the VA is currently allowed to do), a practice which is currently forbidden by the new Medicare prescription drug benefit legislation.
  • Oversight Requirements:  Under this proposal, adequate – but not oppressive – oversight over the quality and timeliness of care, over the decisions regarding approval or denial of coverage, and over other appropriate aspects of the health care system would be established.
  • Prioritized Needs:  Under this proposal, a system would be established for determining the priority of medical need, (as opposed to elective medical procedures) that empowers medical professionals (rather than accountants), in consultation with their patients, to make these determinations based on the medical needs of the patient – rather than on some company’s profit margin.
  • Tax-Free Individual Health Savings Accounts:  Under this proposal, these accounts (similar to those previously proposed by President Bush, among others) could be used by individuals to pay the premiums necessary to add additional benefits to their selected certified plans, or to pay for specified elective procedures, treatments, or other expenses not covered under the new system (within set guidelines).


Where Will the Money Come From?


Perhaps the most vexing question of all is the obvious one – how will we pay for it?  Most Americans want health care reform that covers everybody, and many even say they would be willing to accept a tax increase to get it.  Should we cut back on other services?  Probably – but there simply aren’t enough services to cut that would free up the amount of funding needed, so this would be nowhere near enough. Besides, while no one disputes that government spending is out of control and certainly represents a huge problem – the national debt has more than tripled just since George W. Bush took office, recently surpassing $9 trillion – that is an issue for another discussion.  Any ‘earmark” or “pork barrel” project passed by Congress was proposed by a Member of Congress to provide some benefit to their state or district (or to a campaign contributor – which brings up yet another issue extraneous to this discussion:  the issue of campaign finance reform), and therefore cutting those projects would be opposed by those same Members of Congress.  Until this issue is resolved (Line-Item Veto, anyone?), cutting such projects would not be a reliable source of revenue, so we will have to find another funding source for the new health care system – which probably means a tax increase of some sort.  This will undoubtedly be the least popular portion of the proposal – in fact many will fight tooth and nail against it – but frankly, anyone who says we can provide universal health care without raising taxes is either a fool or a liar; whatever form the new system takes, it will cost a whole lot of money.  Where should this money come from?   I propose using five specific sources of revenue to fund this proposal (I will leave the determination of the exact amounts, percentages and ratios for the different sources to those with the appropriate expertise):

  • Current Government Expenditures on Health Care: Government programs that already provide health care, such as Medicare, Medicaid and SCHIP, would be incorporated into the new system; these programs would of course no longer be needed as people currently covered by these programs would be covered by the new system instead (the VA system would remain separate due to the unique needs of its patients).
  • Current Business Expenditures on Employee Health Care Benefits: A portion of the money that businesses currently use to provide health care benefits to their employees would be tapped. While this money comes from the employer, it is part of the total compensation package for the employees.  The employees have never seen this money in their paychecks, however, they have received it in the form of health care benefits.  If those same (or better) health care benefits were provided some other way (such as by the government through this new system), the employees would still receive the same pay and (probably better) health care benefits, and would therefore not miss that portion of their compensation.  The employers are already paying that money out, so they wouldn’t miss it either.  I would propose that a percentage of this money, in some combination of employer/employee responsibility, be utilized in the form of a payroll tax.
  • Excise Taxes on Specific Products: The use of certain products – such as alcohol, tobacco, particular snack foods (e.g.: “junk food”), automobiles and motorcycles (and the gasoline they run on), and specific sporting equipment – contribute mightily to the cost of providing health care, and new taxes on these products, in an amount relative to their nation-wide impact on the cost of providing health care, would be imposed to help alleviate these costs.
  • Reduction in Administrative Costs:  In our current health care system, fully one-third of the nation-wide costs are administrative, rather than treatment-related.  The volume of paperwork and other administrative costs involved in providing health care would be drastically reduced under this plan, however patient privacy would continue to be ensured.
  • National Sales Tax: The remaining difference between the revenue raised by the above sources and the revenue needed to fully fund the new system would be raised through the imposition of a new national sales tax.  This has many advantages over other methods of raising revenue (such as an increase in income taxes):  First, this money – along with the money from the above sources – would be specifically allocated by law for use in funding the new health care system – it would not simply be added to the general fund, could not legally be spent on anything else, and could not be “raided” for any other use (as has been happening with the Social Security fund).  This would allow the new health care program to be fully funded year after year (the tax could be set at a rate that would ensure this), meaning the program would never lead to national bankruptcy, nor would it ever add to the budget deficit.  Second, this would alleviate concerns that this program would be some sort of new “entitlement”; each and every person in the country – even undocumented immigrants who stay for an extended period – would be paying into the system each and every time they made a purchase of anything (except for appropriately specified grocery items).  Third, the imposition of this tax would be spread out over the course of the full year, meaning no one would have to take a large financial “hit” at any given time of year (as occurs now with income tax).  Fourth, there would be no significant problems related to the collection of this new tax – the money would simply be collected at the time of purchase the same way state sales taxes are now (in most states), and forwarded by the businesses to the government in the same way.


There are those who will argue that the cost of implementing this program – particularly the imposition of the national sales tax – will discourage purchases and would therefore have a detrimental effect on the national economy.  To a point they would be correct, but I believe that they are failing to take into account the constant dampening effect our current health care delivery system has had on our economy. Removing this dampening effect will, I believe, at least counteract – and likely outweigh – the detrimental effects of the national sales tax, yielding a net gain for the national economy.  This net gain will grow over time, as health care costs would be brought under control rather than continue to spiral out of control.


The Advantages of Dave’s Proposal


The advantages of such a plan are manifold.  First and foremost, the plan would cover all Americans – without exception.  There would be no more exclusions, necessary procedures denied, or personal bankruptcies resulting from catastrophic or long-term health expenses.  Everyone would be covered.  Period.  Universal coverage, and the lack of co-payments (hopefully we could eliminate co-payments altogether) would ensure that anyone and everyone who needed it would seek medical attention early, when interventions generally cost far less, causing fewer outbreaks of contagious diseases, and leading to healthier lives for all of us.  Second, the plan would be fully funded every year, in an affordable manner that does not increase the deficit, and therefore does not burden future generations.  Third, all Americans could choose their own doctors – even specialists.  Fourth, the plan includes flexibility  If you would rather purchase your own health care, or if your employer will provide your health care benefits (presumably better than the certified plans) as a means of recruiting you to work for them, or if you want to add additional benefits to your plan, all of these options would be allowed.  Fifth, all of the market incentives to provide exemplary care, develop new technologies, and minimize extraneous costs would continue to exert their forces on businesses involved in the health care system.  Sixth, no business currently providing health care or related services would be displaced.  While insurance companies would lose the ability to continue raising their premiums at rates wildly beyond anything justified by inflation, they would benefit from the fact that 47 million new potential consumers would be entering the market.  The pharmaceutical companies won’t be happy, but while their practice of gouging America for prescription drugs would end, they would also benefit from the entry of 47 million new potential customers into the market.  As it stands now, the prescription drug benefit added to Medicare will bring the pharmaceutical companies over $700 billion over just the first ten years – and that only covers Americans over the age of 65.  A plan that covers all Americans will certainly provide enough revenue for the pharmaceutical industry to continue to encourage the development of state-of-the-art medications.


Fleshing Out the Details


There are several remaining issues that will need to be “fleshed out” in terms of specific details:

  • Undocumented Immigrants:  We would have to determine, once and for all, what we are going to do about undocumented immigrants who need health care (see “Undocumented Immigrants” section for more discussion of the issues that remain unresolved in relation to this issue).
  • Enforcing the Mandate:  If we “mandate” that all Americans join the new plan, this implies that there would be a penalty for anyone who failed to do so (either by enrolling in a coverage plan or “opting out” by verifying coverage from another source).  This penalty would need to be determined.
  • Funding Formulas:  The exact formulas for determining what portion of the funding for the program would come from which source would need to be determined.
  • Reductions in Administrative Costs:  The exact means of reducing the amount of paperwork and administrative costs across the board would need to be determined.
  • Tort Reform:  The precise formulas to be used in determining the caps on malpractice damage awards and malpractice insurance premiums, the penalties for fraudulent or frivolous claims, and other specific aspects of tort reform would have to be agreed upon.
  • Oversight:  The levels and form of needed (but not oppressive) oversight over the quality and timeliness of care, over the decisions regarding approval or denial of coverage, and over other appropriate aspects of the health care system would need to be determined.
  • Prioritizing services:  The details of a system of prioritizing medical need, particularly over elective procedures and treatments (e.g.: tummy tucks, face lifts or sex-change operations), would need to be established, with an emphasis on the medical needs of the patient (not profit margins), as determined by medical professionals in consultations with their patients (not by accountants).
  • Minimum Coverage and Additional Coverage Options:  We would have to determine exactly what services, treatments, procedures and products would be covered under the certified plans (As stated earlier, I would pattern the minimum level of coverage on the exemplary health care coverage currently provided by the taxpayers to United States Senators and Representatives).  Would the certified plans include alternative medicine, such as acupuncture, chiropractic care, or homeopathic treatments? While certain dental health needs (such as treatment for an abscess or a root canal) would clearly fall under the general health coverage, would more basic dental coverage, such as cleanings, fillings, sealants and fluoride treatments be included?  What about orthodontics?  Certainly ophthalmology (treatment of medical conditions in the eye, such as cataracts and glaucoma) would be covered, but what about Optometry (basic vision treatments – glasses, contact lenses, etc.)? Would psychological treatment (e.g.: therapy) be covered?  Any of these services – and others not listed here – that are not covered under the certified plans would be available as additional coverage options at the individual’s expense (although the money they use to pay for it could be set aside tax-free in new “Health Savings Accounts”), at a cost determined by market forces.  These options would be provided by the same insurance company that provides the selected certified plan; what additional coverage options a given company offers – and at what cost – would be a key factor in the selection of a certified plan in the first place.


I offer this proposal as a starting point – as noted above, more details need to be worked out.  I welcome your comments and suggestions (, especially regarding the remaining issues listed above.


Some things are worth fixing.  It is obvious to anyone who takes a close look at our broken health care system that this is one of them.  No one said it would be easy, but this is America.  I believe that together we can do this.


© 2009 by David Bleidistel.  All rights reserved.