The FDA may limit how much nicotine can be in cigarettes (here).
My reaction? Finally!
You see, I’ve been thinking a lot about health care. I think it’s a tricky topic as it involves four items that can be mutually-exclusive of each other in a policy debate. Here are the “Big Four” in my book:
- Who pays
- Personal liberty
Health care reform is a tough topic, as it involves tradeoffs among those four major issues. Here’s what I mean.
The ACA is legislation that offers universal coverage through exchanges, the elimination of barring those with pre-existing conditions, and a large expansion of Medicaid…via funds from the wealthy, medical devices companies and the young and the healthy…via three additional taxes and the use of a penalty on those who do not have insurance…and mandates EMRs and the start of measuring outcomes.
So, that’s a mouthful. Even writing it out takes a lot of effort, but that’s my attempt at summarizing it. Here’s an even shorter summary:
- Coverage: as many as possible
- Who pays: the wealthy, med. devices companies, the young and healthy
- Personal liberty: taxes and a penalty for those who don’t have coverage
- Costs: early attempts to go to outcomes measurements
IMO, the bill optimized for coverage. (In fact, I’ve long surmised that, in exchange for Sen. Ted Kennedy’s crucial endorsement, then-candidate Obama agreed to make a health care bill his #1 priority upon taking office. That was the horse trade. Universal coverage was Kennedy’s big dream, you can’t pay for it without forcing the young/healthy to get insurance, and Obama wasn’t for the private mandate in his debates against HRC. But, I digress.)
Conservatives feel the legislation hits some of their hot buttons:
- Who pays: those who make good lifestyle choices are subsidizing those who choose to make unhealthy choices; insurance premia for many are skyrocketing
- Personal liberty: it is government overreach to force people to buy a product they don’t want
- Costs: “blank checkbook” expansion of Medicaid is unsustainable and fiscally irresponsible
Similarly, the recent GOP attempt at reform received tremendous backlash, with those on the left rallying against a repeal of taxes on the wealthy (who pays) and the projected increases in the number of the uninsured (coverage).
So, yes, we are in a kerfuffle. We are bouncing among the Big Four and unsure as to how to optimize for the whole. What is our #1 priority and how do we make the tradeoffs?
As I’ve blogged before, I’m for universal coverage and a registered Independent. I’m OK with paying more taxes. I’m annoyed but understand that I’ve had to pay significantly more for health care as my premium goes up by a lot each year.
But, I’m here also to write that an “open checkbook” for Medicaid is not sustainable, as both Medicare and Medicaid together are now almost 25% of all Federal government spending (details here).
So, I’d love politicians to consider ways to encourage better health. Stop subsidizing corn crops and impose a corn syrup tax? Yes. Cut the amount of nicotine in cigarettes? Yes. We need to do something, in all honesty.
The best health care system I know of is Singapore’s. Mrs. T. and I lived there for a few years. No, it isn’t the land of personal liberty, but, boy, that system really works. What once a swamp 50 years ago is now a nation with one of highest GDP-per-capita ratios, even higher than in the U.S.
You can read more about Singapore’s system here. But, note that is an amazing set-up: It is both government-run, but, also, forces individuals to take responsibility for their health care and pay for the lion’s share. Health care there is first-rate, and they pay a fraction of what we do (about $2,800 a citizen vs. $9,400 here).
We in the U.S. need to make some tradeoffs. This is a critical time for Presidential leadership, I have to say, to try to articulate a vision that balances trade-offs among the Big Four. And, can anyone in Congress ignore the lobbyists and SuperPACs?
Anyone? Anyone? Bueller?