Single payer health care should not fade away with Kucinich . Thereby, this is a follow up to the single payer issue brought up in my blog, “Another Plea for Health Care”. Fortunately, the reactionary political climate did not stamp out the health consciousness that has spread throughout the country since the '92 campaign. It would be ridiculous, then, for the nation to deny the maintenance thereof. Health is a necessity; it is no less significant than national defense or police protection. Health coverage no less than education is a matter for government. Were it not, it follows there should be education insurance whereby those with low IQs would be thrown into a high-risk pool of grubby schools. Health unquestionably is for the common good and only an enlightened government can secure the common good. That there should be a governmental single payer is not to say that giants such as Blue Cross, Metropolitan, Ænta, should be tossed aside. Their administrative expertise but risk-free could be contracted to oversee fraud and over-charging. Right now the government, aside from direct payment for Medicaid and Medicare, is the indirect payer through IRS. This point cannot be stressed enough: Business deducts insurance costs, physicians deduct mal-practice insurance, unpaid bills are written-off — all are the taxpayer's burden. In addition, inflated costs owing to the under-insured or uninsured are borne by the insured or taxpayer.

Lest the single payer be seen as the creation of another bureaucracy, remember there is already Medicare machinery in place. If, however, it is determined that several of the larger insurance companies are indeed more efficient — experience testifies otherwise — then they could be awarded a contract to administer the payment end in behalf of the government. But the important thing is that they are no longer decision makers at the risk end of health care insurance — no longer accepted as a logical term — and the patient thereof no longer at risk too. Consider the insurance companies of the future as in the service of office management in behalf of the single payer, the federal or perhaps state government. Using their operations already in place would also ease mass white-collar layoffs in the insurance industry.


Character of the Supplier


Physicians have to begin to take a hard look at themselves — including the superstars of medicine, though admittedly unusually crack surgeons do deserve a shadow of what entertainers and ball players have. They're not the only ones with four, five, six years of graduate work. There are hundreds of thousands out there with as much and more education that do not feel they have a God-given right to be entrepreneurs and are perfectly at peace with modest salaries. Countless doctors at universities working their hospitals and clinics with greater case loads and find time to teach and do research, still preserve a philosophic temperament when they deposit their paycheck. They are better physicians because they are not beset with the halter of running a business. They leave all that baggage to the experts and supportive personnel while they concentrate on what they do best. Noble rural doctors who take their Hippocratic oath seriously seem proud, if not fortunate, to be labeled part of the middle class.


Physicians, then, have to retool their thinking and spend some analysis-time on their patient's medical records prior to office hours in order to treat effectively in lieu of the hectic rush jobs to unload them for the next on line; getting to know them as human beings might prove rewarding and result in better medicine practice. Who knows? — they might even rediscover the lost art of house calls. Far better for the environment for one physician's car on the road than twenty patients'. The profession should cut and paste the Hippocratic principle to the spreadsheet of growing profits. Physicians are artists of medicine, not slick manipulators of commerce.


Pharmaceutical companies have got to realize that what they do is not simply a matter of profit. There are two sides to the coin of drug-making. Off-the-counter items is a commodity to be marketed like any ordinary product. On the other side, however, they are dealing in real medicine and research for public survival and well-being and ought not to engage in wasteful competition and marketing; they ought to be guided by public trust to minimize prescription cost. They deceive the public with the phony argument of the cost of research — much of which is piggybacked on work at universities — and the public no longer should tolerate this hoodwinking. The ill who cope with exorbitant prescription charges know the why of the enormous rise of pharmaceuticals on the stock exchange. The public should be aware that excessive costs go to marketing and lobbying. The public should know that most research worthwhile is conducted at universities or by small dedicated companies blest with a sense of mission. The public in comparing generic with named drugs would see all too clearly the vast difference in profit margins.


The playing field must be leveled. The bulk of today's work force and its families does not have the advantage of yesterday's powerful unions and a congress that cared. Workers should not be scapegoats because of the callous governance of the past twenty-five years. There have been no Hubert Humphreys, no George Meanys to protect the human rights of the working man or woman.


Health Care of the Future


Therefore, under the inevitable future proposal of a complete National Health Plan, contractual obligations from collective bargaining relative to health care are irrelevant and therewith terminated. Dental benefits would not apply to this rule until such time as the National Health Plan includes this equally obnoxious cost spiral. Schedule A [returned to the fairer 1% of gross income calculation] medical expense would be limited to dental care and miscellaneous expense such as extensive travel to hospitals for those with serious illness. [Eye glasses would be included in the plan but limited to the lens and bare bone frames, not high fashion frames. All other basic equipment of medical necessity would also be absorbed by the plan.]


The National Health Plan would be unrelated to employment. Any contract derived from collective bargaining may be re-opened for the express purpose only of recapturing compensation that reflects the value of the terminated company health plan. Nor will there any longer be need of a secondary carrier built into many retirement plans as Medicare will be fully upgraded to the high level of the National Health Plan. Preparation for this universal coverage is as follows:


 

1. The social security office, in conjunction with the IRS, will issue a plastic card inscribing a social security number prefixed by 'NH' to all taxpayers and non-filing dependents under eighteen as inscribed on joint and individual tax returns. Eventually, each card will contain description of holder, preferably a photo.

2. To be eligible, all Medicaid recipients will have filed tax returns for the previous year whether or not previously required, and whether or not employed.


3. All those of non-tax roll or with inactive social security numbers [except dependents under eighteen duly included on existing tax returns] will be required to file a tax return with a notarized declaration of no income.


4. Dependents over 19, not on the tax rolls will evidence full time student status, together with a notarized letter that they are not part or full time employees illegally hired off the books. The disabled not under social security must register by forwarding a physician's statement of disability. [Job-hunters must register with the state Unemployment Agency, which will forward verification to the office of social security for temporary issuance of NH card; permanent status will not be issued until off-the-books employment is shown.]


5. The homeless must register with the Unemployment Agency for verification of dire status, and citizenship or a green card.


6. All businesses, large and small, must attach an audited financial statement that all employees are legitimately registered and that no others have been omitted from the official payroll.


7. Underground labor of any and all kinds choosing not to comply will not be eligible for National Health coverage. Under a medical emergency those involved in underground and illegal goods and services will, of course be treated, after which they will be fined and/or imprisoned. Illegal immigrants will be returned to their native country.


This is a no-nonsense plan predicated on the individual's ability to pay. By the powers of Congress, under Article I section 8-1, health care is forever sealed under government expenditures so that all citizens will gain security in never again having to wonder if the individual — especially when laid-off — or the family is fully covered. This proposal is totally inclusive, from prescription to transplants, in order to insure that prevention and maintenance take hold. In spite of this, some rationing of the more esoteric services may have to come into play. Foregoing extensive surgery on the elderly that has a crippling effect on their general well-being might well be justifiable. Relieving discomfort is the general rule for the elderly and the terminal ill. Extensive or special therapy — unless deemed a matter of life and death — for young and old not available locally or not yet networked frugally has to be denied unless the family wishes to make the monetary sacrifice of additional travel costs. However, every effort will be made to make available high technology across the country. Determined by medical consultation, artificial life-support for the terminal or "brain dead" patient would be removed. Long term comatose victims must be expedited to home care and eventually at some point life-support denied. When all treatment fails, those with cancer and other deadly disease, should be allowed the dignity of home and hospice care. But under no circumstance when there is medically warranted hope, should ignoble frugality come into play.


The new system will work toward the development of computerized input of patient identification and provider services wired to the government or designated agency for payment. It will be the demise of the pen, patient forms and receipts. The patient or holder will insert the NH card into the provider's computer [a pin number might be advisable to minimize fraud]; and the provider takes it from there filling in codes of services. The only paper involved will be hard copy back up for provider files and for submission to payer for periodic auditing of services.


Cost-containing strategy of the proposal of the future would begin to make its mark, together with a windfall of freeing wider purchasing power, or increasing savings. Plus this new plan would eliminate Medicaid costs to the state; thereby generating a surplus for each state to begin health care projects and training targeted at long term health care for crippling diseases and accidents. The majority of long-term care cases require but part-time home care. Some of the community service expected from welfare recipients with proper training could help fill this need. Training of more practical nurses and paramedics could lick the problem of long-term care altogether. Other long-term cases require day care, much like child care, for two-income families, or a single parent, who must work. Or it may be the working offspring of an elder in need of day care. Families emotionally devastated by Alzheimer, particularly the spouse, are in need of this paraprofessional comfort therapy and in the last stages of total alienation. Public-nursing homes should be provided for the Alzheimer victim and the social security check of either spouse, whose ever is lower, is electronically remitted to the provider as payment for nursing care. [Costs beyond that, if necessary, would be carried by the states.] Careful scrutiny of nursing home operating costs should be underscored because the cost of nursing care apparently far exceeds the cost of hospices. Perhaps, then, in lieu of nursing homes, there ought to be hospices and vacant VA wards for other than the terminally ill. In this state scenario payment of services would still be from the federal government, but construction and hardware would be the responsibility of the state.


How is all this paid for? First, as cited, cost-containment of the system by reassessment of practices, simplified services, reduction of paper work, drastic curtailment of malpractice awards, prevention and accessible maintenance, would immediately have an effect, thus aligning the costs to normal inflation. In addition—everyone is paranoid about health care, though not anxious to "pay" for it— preparations as proposed above for eligibility of the plan would drive untold numbers who are off the books to hop on the wagon. The threat of severe penalty and possible imprisonment for those who do not have a plastic card to show when they beg for health care, might be just the incentive to draw the hard-core out of underground tax-shelters and breathe freely under the aegis of government coverage. Corporate profits and wages would be higher because the monkey is off the back of the employer, job-training and infrastructure projects would begin to show results in greater and better employment.


The revenue generated from this proposal — obviously entailing higher taxes — would begin to ease the state tax burden. The affluent—and they would still be around—would be motivated to invest in job-creation, contribute to scholarships, give to worthwhile charities. At long last the thousand lights flash on. Further, in most towns and counties round the country, the medical profession and hospital, with perhaps the exception of the local school district, are the largest employers, and with this proposal opening up to paramedics, it will become even larger. “Costs” should not be looked upon as negative when they create jobs and stimulate the economy; critics tend to think in terms of the high fees of doctors, forgetting that they are also employers of millions. Greater disposable income of the lower class would generate more widespread consumption and thus keep the essential economies thriving and might even leave a few of the lower income some coins to join the ranks of investment or savings. The states would get richer from greater revenue-sharing in addition to lightening their own tax burden in virtue of sales and property tax from more consumption and new low cost homes.


Contrary to common belief, the rich would work smarter and harder in order to enhance the slimmer surplus now allowed. And in the isolated cases whereupon the rich perceive a high rate of tax as a disincentive there are ten times as many willing to take their place. The inverse happened in the '80s. Corporations and affluent executive management grew so fat and content from their tax breaks that the leaner Japanese pushed them aside.[The quality of athletes have diminished dramatically and proportionately to the inflated value of their multi-year, multi-million dollar contracts. Mays, Mantle, Aaron, Williams were kept "hungry."]
 Copyright © 2004 Richard R. Kennedy All rights reserved. Revised: February 13, 2004.