The United States National Health Insurance Act (USNHI) – H.R. 676

On January 27, 2008, U.S. Representative John Conyers Jr. (D-MI) introduced a new version of a previously unsuccessful bill before Congress that would turn America’s health care system into a socialized, not-for-profit, singer-payer system.  Previous iterations of the bill had few co-sponsors (25 in 2003), and the current version (H.R. 676), has gained a modicum of traction thanks to Michael Moore‘s film documentary, Sicko, which contends that the United States is the only developed country that does not currently have “universal health care.”

As an advocate for market-based health care (which we currently do not have), obviously I have problems with 676.  A few days ago I attended a lecture and discussion about the bill, presented by advocates in favor of it, to an audience of comprised mostly of naive first and second-year medical students…with one of two true skeptics interspersed within.  Below I present a few of the problems with 676 and with single-payer health care in general.

First, the highlights of the proposed law.  676 purports to cover the following: primary care and prevention, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, the full scope of dental services (other than cosmetic dentistry), substance abuse treatment services, chiropractic services, basic vision care and vision correction (other than laser vision correction for cosmetic purposes), and hearing services including coverage of hearing aids.  Basically everything.  And you can go to any doctor or provider you want.  And there’s no deductibles, copayments, coinsurance, or other cost-sharing to be imposed with respect to covered benefits.  Sounds nice doesn’t it?

The cost.  I haven’t read the feasibility studies, but the text of the bill says all of this wonderful stuff, for every American citizen, will be paid for with income tax increases on the top 5% of earners, a progressive excise tax on payroll and self-employment income, existing government health care revenues, and a tax on stocks and bonds.  Additionally, the bill foresees a 15-year integration process, which will be paid for by issuing Treasury Securities.  Congress reserves the right to decide how much to tax the American public, it’s a basic tenet of our system of government…and with the guidelines above, we’re looking at a legislated equivalent of a blank check.  Why?  Because providing comprehensive, quality, accessible care to every citizen will command a budget possibly larger than any other ever conceived by man.  The U.S. Treasury will issue hundreds of billions upon hundreds of billions in debt to fund the 15 year transition period.  Just to “integrate” the new system, we are looking at compounding our debt (which is owned mostly be foreign investors), by nightmare proportions.  We will no longer own our own country.  Our grand-children and great-grandchildren will spend their lives paying interest to Dubai, India, China, Russia, and Japan.  The dollar will continue to weaken…perhaps it will reach parity with the Mexican peso.  Additionally, depending upon the size of the taxes necessary just to drive the operational side of this beast, there will be significantly less incentive for businesses to continue to exist on U.S. soil.  An excise tax on self-employment income is the government’s way of telling entrepreneurs and business owners to get f***ed.  

Medicare is poised to make up a record amount of our GDP in a few years…it’s already unsustainable and will soon be bankrupt in its current form.  It should be noted that the current form of Medicare covers only elderly people, and only pays for a fraction of the services listed above.  The USNHI proposes no revolutionary way to reduce the costs associated with administering an undertaking, which expands Medicare’s coverage on a exponential scale.  This is an atomic bomb. 

Private insurance becomes illegal if 676 is passed.  We use the term “universal health care” in quotations to describe countries like Israel and the United Kingdom, because these countries HAVE private insurance options.  People who can afford to, pay for supplemental private insurance, because even with smaller, more homogenous populations, these countries are not able to provide a fraction of what 676 promises.  And that’s with high personal income taxes, and very little defense spending (with the exception of Israel, most countries with quasi-socialized medical care depend on us for this).  In Canada, people routinely pay bribes to skip the line. 

This brings me to my next point.  Banning something the market is screaming for is like leaving picnic food at a park and putting up a “no ants” sign.  It’s a comical act of futility.  And it costs billions of dollars.  We have a country with a revolving door border policy.  Our government has spent hundreds of billions on drug enforcement…how well is that working?  How many people in this country own firearms purchased without proper licensing on a black market?  If you don’t allow for a private tier of health care payership, you force a black market to form.  Then you have to create government agencies to enforce and prosecute illegal “pushers” of private health care.  This cost isn’t factored into 676. Perhaps we could charge a “modest” excise tax…

Doctors will have no opportunity to attain true wealth.  Under 676, providers may elect to be paid government-dictated salaries, or reimbursed at government-dictated rates for services rendered.  Current private Health Maintenance Organizations (HMOs), who are the target of 676 supporters, reimburse doctors at a MULTIPLE of Medicare reimbursement rates.  This is because doctors cannot afford to stay in business strictly on Medicare payments.  With skyrocketing malpractice premiums forcing many doctors into retirement, we could be looking at a future with no domestic doctors.  676 does not (and legally cannot) address medical malpractice – medical licensing and tort reform are handled on a state level.  Doctors have little incentive to exist in this environment, particularly those doctors facing hundreds of thousands in student loans…which is most of them.  676 does not address medical school tuition.  With no primary care physicians, the queues will grow quickly.  In Canada it takes 10.1 weeks to get a CT scan.  How long will it take in a country our size?

Then there’s the problem of illegal immigrants.  676 only covers American citizens.  Are we prepared to deny all care to illegal immigrants?  I doubt so.  The cost of providing similar care to this demographic (making up a significant chunk of the population), has not been factored into the bill.  Taxes go up more.  A true welfare state. 

There’s a slippery slope here.  At some point you have to decide whether you’re country’s mission is Capitalism (the American Dream), or Communism (from each according to his ability to each according to his need).  I don’t think we’re ready to give up the ghost quite yet.  The great empires of the world had much longer tenures than 200 years.  Are we ready to become a welfare state, and give the crown to a new empire?  The next empire probably isn’t going to be as nice as us.  It probably isn’t going to drop food and vaccines on African villages…

Finally, the perfect irony.  The purveyors of USNHI tout it as the answer to large for-profit HMOs that put shareholder interests and CEO salaries before patient well-beings.  What?!  By putting the government in charge of it?!  The same government that takes handouts from special interests groups that represent all kinds of nasty interests perpendicular with those of individual American health care users?  Corruption was invented in Congress.  Congress created the original food pyramid to promote the interests of the U.S. Agricultural industry, not our health.  That’s why it recommended 5-11 servings of starch per day.  One could cogently argue that the government created type II diabetes to help the American farmer.  If you read history, governments, especially those with absolute power, don’t have the best track record in the human rights category.  There was this guy named Stalin, maybe Michael Moore should do a documentary…

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Politics

John McCain (re: health care in the USA):

“For all the grandiose promises made in this campaign, has any candidate spoken honestly to the American people about the government’s role and failings about individual responsibilities? Has any candidate told the truth about the future of Medicare? Its costs are growing astronomically faster than its financing, and leaving its structural flaws unaddressed will hasten its bankruptcy. Has any candidate warned that we have a personal responsibility to take better care of ourselves and our children? Yet that is the only way to prevent many chronic diseases. Has any candidate insisted that genuine and effective health care reform requires accountability from everyone: drug companies, insurance companies, doctors, hospitals, the government and patients? Yet that is the truth upon which any so-called solution must be based.

“Democratic presidential candidates are not telling you these truths. They offer their usual default position: If the government would only pay for insurance everything would be fine. They promise universal coverage, whatever its cost, and the massive tax increases, mandates and government regulation that it imposes. I offer a genuinely conservative vision for health care reform, which preserves the most essential value of American lives — freedom.” – The Health Care Blog

Hillary Clinton (re: universal health coverage through force – a response to George Stephanopoulos‘ question):

When Mr. Stephanopoulos asked a third time whether she would garnish people’s wages, Mrs. Clinton responded, “George, we will have an enforcement mechanism, whether it’s that or it’s some other mechanism through the tax system or automatic enrollments.” – New York Times

I see two distinct philosophies when it comes to health care.  Republicans: personal responsibility.  Democrats: everyone else’s responsibility.  Of course, these core values are seldom stripped of their politically correct “cocoon language,” as it were…but when you break it down – that’s what we are looking at.  Perhaps I’m oversimplifying…

Or perhaps not.  The New England Journal of Medicine (thank you to the HealthPopuli Blog for pointing this out), did a political survey that is available to everyone for free.  One of the most striking results is that 94% of Democrats surveyed think it is a serious problem that some Americans are lacking health insurance.  Only 55% of Republicans feel this way.  45% of Republicans felt it was a person’s individual responsibility to ensure that they have health insurance.  Only 13% of Democrats felt this way.  Interestingly, 74% of Democrats are willing to pay higher taxes so that all Americans can have health insurance (vs. 46% of Republicans).  I’d be curious to see how many of those Democrats are currently paying for other people’s health insurance, out of their own pockets, out of the goodness of their hearts.  Wouldn’t it be so much more efficient, if you truly did believe you had a moral obligation to support the uninsured, to just find somebody without health insurance and subsidize them directly?
79% of Democrats favor an insurance mandate (the Hillary plan cited above).  This many sound like championing individual responsibility…but what it truly means is raising taxes and giving the bill to everyone else.  44% (surprisingly high) of Republicans favor this.

Finally, 65% of Democrats said they would support a candidate that proposed a plan to insure everyone even if it mean significantly increasing government spending.  A plurality (42%) of Republicans favored reducing health care spending.   Perhaps McCain and Clinton truly echo basic values of their parties.  Perhaps they have fantastic campaign researchers and are just pandering.  But it really is true, Republicans overwhelming favor people taking personal responsibility for their wellness.  Democrats overwhelmingly favor people placing this burden on others.  I’m not a Republican nor a Democrat, but I have to ask: what incentive do we have to be healthy if, at our very core, we’ve assimilated values that entitle us to our more productive citizenry’s charity?

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