The mistaken notion that healthcare is a right comes from the so-called “Economic Bill of Rights,” articulated by President Franklin D. Roosevelt on January 11, 1944.
“ObamaCare” as it is currently constituted, depends on altruism to control costs. Its major shortcoming is the lack of a mechanism to keep costs down. Healthcare must be tackled not only from the payer side, but also in its management and cost effectiveness to reflect global rates. In order to do this, we must trim the associated bureaucratic bloat. “ObamaCare” does not factor in the flaws in human nature, which certainly extend to the individuals who manage and run our healthcare corporations. If we are honest with ourselves, we will admit that we are not naturally altruistic. It is much more realistic to harness free market forces where appropriate and to encourage people – and corporations – to do right based on incentives.
Though I am by no means a healthcare professional, here is my humble proposal to make universal healthcare economically feasible.
- Each adult would be required to have a Medical Account that would include a government funded health insurance policy covering 100% of medical expenses after a $20,000 annual deductible. By bargaining with the competing companies, this would probably cost less than $100/month. Also included in the Medical Account would be a self-funded tax-free Health Savings Account to cover the deductible.
- Dependents with no earnings would be covered by the Medical Account(s) of their adult provider(s).
- Once the dependent starts earning money, their own account would be set up.
- The contribution to the Health Savings Account would be withheld from the individual’s paycheck automatically.
- To cover the difference between the Health Savings Account and the $20,000 deductible, a “gap health insurance” policy would be set up. Individuals would be free to choose their gap insurance from competing companies on a national basis.
- The modest premium would be included in the Health Savings Account contribution.
- If the Health Savings Account falls below $20,000, a new gap policy would kick in.
- The amount of gap insurance and its premium would diminish with the growth of the Health Savings Account and would disappear once the Health Savings Account reaches $20,000.
- In the case of unemployment, the contributions to the Health Savings Account would be covered by unemployment insurance.
- Once the individual reaches 65, he or she would have the option of rolling over to Medicare advantage while retaining their Health Savings Account.
- For those who are self-employed, the existing IRS rules would apply to include the Medical Account.
- For those on public assistance and/or Medicaid, the Health Savings Account contribution would be withheld from welfare payments and Medicaid would be restructured to resemble Medicare advantage. (Our current welfare system as a whole should be restructured and incentivized in order to encourage recipients to move from a culture and lifestyle of poverty to one of self-sufficiency.)
- If the individual dies with money in his or her Health Savings Account, it will be transferred to the Health Savings Account(s) of their designated heirs.
Clearly, this proposal is not comprehensive; it is, rather, an outline of suggested principles intended as a basis for discussion. Of course it will have to be tweaked so that people will not be forced to participate in a plan that includes morally objectionable medical procedures, etc.
There is at least a two-fold advantage in this proposal. First, no one would have to carry the financial burden of those who do not pay for emergency room visits, etc. Second, everyone would have a vested interest in acting as watchdog on their own medical care cost, since the initial payments will come from their Health Savings Account. For example, it would now make a difference to the in-patient if his or her Tylenol came from the hospital pharmacy at $3.00 per tablet, or from the pharmacy across the street at $3.00 per bottle.
Our culture no longer places great value on the concept of saving, for various reasons. Some are currently living paycheck to paycheck due to unfortunate circumstances, while others have never learned to save at all and live in a perpetual cycle moving from one financial crisis to another. For this reason, a Health Savings Account cannot be borrowed against, used as credit or treated as a liquid asset.
Those who abuse the system should be penalized. Yet individuals who practice preventative wellness (including pre-approved ‘alternative’ care) and corporations that practice cost saving measures while maintaining quality care should be incentivized and rewarded by the government.
I’ve observed that a growing number of doctors no longer accept Medicare alone. To have access to their services one must have Medicare supplement insurance. Those who cannot afford this will fall into a bottom tier of healthcare. Perhaps in the near future, doctor’s offices will sprout signs isaying, “We do not accept ObamaCare alone,” and for this, too, supplemental coverage will be required.
Unless our society takes the flaws in human nature seriously, we will continue to suffer the costly effects of abuses from individuals and institutions. In my view, “ObamaCare” as we know it will either return us to the two-tiered healthcare system it was supposed to eliminate, or it will drive many physicians out of their practices leaving government care as the sole choice.
Without taking into account our natural tendency toward depravity, more money will be wasted on both the payer and bureaucratic sides as America’s economic pulse weakens to an inevitable flat-line – with no adequate means for resuscitation.
Dr. Carl Ellis, Jr. is a theological anthropologist and Assistant Professor of Practical Theology at Redeemer Seminary in Dallas, TX. Copyright pending on Health Care Savings Plan. Follow Dr. Ellis on Twitter: @CarlEllisJr