Tuesday, August 4, 2009

A Fool and His Money Are Soon Parted (Or Why I Believe the Current Health Care Reform Won't Work)

There is one reason, first and foremost, that I believe that this health care reform will not work. We don't have the money to do it. In a way, it's even more ridiculous to believe that we have the money for this than to believe we really had the money for all the bailouts and stimulus. At least, in theory, money shovelled out for the bailouts and stimulus would be either paid back or returned back into the economy by growing the economy. While professing to make health care less expensive in the long run, this legislation is going to cost us money without earning any new. Money that our government doesn't have.

The real insanity in this is that they are planning on running this health care legislation in addition to Medicaid. So, we already have a system in place that is running throughout all 50 states. This system is funded by both state and federal money, and in many states already is contracting with private insurances to provide managed care for it's participants. Why, in the name of all that is logical and reasonable, would we not look at reforming the Medicaid system, and allow the option for people to purchase policies through that? This very thing is, in fact, done in some states already as low-income people have the option of purchasing private insurance contracted by the state. Running a "health insurance exchange" -- which is not in itself a bad idea -- through each state, with federal law protecting the right to make it portable and limit premiums, just might actually work. Not only that, but it might help to fund Medicaid.
To run this public option from Washington creates the need to pay for:

Addition Federal Staff
Office Space to House Said Staff
Travel Expenses of Said Staff
Multiple Accountability Committees (not paid a salary, but requiring travel fees etc)
Administrative Costs with surveys and research on effectiveness
Staff for handling the actual public option (accountants, doctors, customer service, etc).

Then there most certainly have to be some type of liaisons at the state level.

Which leads me to another reason I know that this health care reform won't work.

It never works to fix something from the top down, and no big national social program has ever been truly effective. If our politicians are going to put forward legislation that is costing the US billions of dollars, it is reasonable to demand that there be evidence that 1) It is the most efficient way to solve the problem 2) that the proposed legislation has a chance of working

Consider social security... this is the same government that brought you this mess. Is there any evidence to believe they will do any better with a national health care option? For significantly less money, easier accountability, and solid health care plans, then there is much more hope that something can be designed on a state level. Countries that have had successful Universal Health Care programs have been countries that are much smaller than the US. Bureaucracy feeds on itself. Our federal government, because of it's size, will do nothing but create a bureaucratic mess with this. Switzerland doesn't create that mess because it's federal government is smaller than many of our state governments. Just the accountability portions of the legislation, alone, was hundreds of pages. It's really not rational to believe that any federal plan is not going to create a bureaucratic mess.

Unfortunately, our state governments are increasingly becoming mere puppet governments for the federal. I learned, recently, that 80% of our state budget is federally mandated and cannot be changed by our state legislature. Now, there is a law that people should be rallying to change. How can we have a voice in our government, when we, the people paying the state taxes, can't influence how that money is spent?

When I consider the quality of service offered through our current social programs, I don't believe for a minute that the public option that the national government is going to offer is going to be any better than Medicaid. I believe that because there is no evidence that it will be better. Ultimately, people with resources will purchase private insurance, and only people with no option will choose the public option, and the discrepancy between the care provided to the rich and poor will either be the same (at greater cost to each taxpayer because we're paying for both programs), or, possibly, worse. And, we're going to feel really stupid since we're already paying for that with Medicaid!

Anytime the government moves a program from the state and creates it on a federal level, then it has defied the concept of "We the people" as the people no longer have a viable voice in our own government. Washington is too big and too far away. I know that the White House is holding Town Hall Meetings, sending out communications and taking suggestions. That is all well and good. However, on a practical level, your voice is simply much more likely to be heard by your local state representative, who's hearing from maybe hundreds of people, than by the White House, where one of hundreds of aides is hearing from, probably 10,000 every hour. It will never make it to the right people, even if your letter is actually read by someone who's voice has finished changing and is able to grow a beard. And, having spent a fair amount of time contacting legislators' offices this past summer, I can tell you that I almost always had to ASK to talk to a grown up. But that's a different issue.

So, these are the reasons I believe that this health care reform will not work. I don't believe the sky is falling, and am hopeful that things can be changed (in part because of the 18 month survey period, and also because there is a clause in the legislation allowing for the development of state wide health care exchanges). Stay tuned for the "Christian" response to the US health care crisis...

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