A Center View

Solving HealthCare.

First, what is the problem we need to solve?

There is a disconnect between the insurance problem that most Americans have and the typical solutions of the political right and left.  Americans are still waiting for a healthcare system that lowers costs, increases coverage, and removes the link between insurance coverage and an employer.  The much debated Affordable Care Act (ACA or Obamacare) did increase coverage for previously uninsured Americans but it did not lower insurance costs for the vast majority of Americans who get coverage from employers or on the individual market.

Our views on healthcare depend very much on whether you work and who you work for.   If you work in the public sector (that is any job for which taxes are used to pay your salary) you are basically okay with your health insurance and healthcare because you have non- existent or low deductibles compared to private sector workers.  You have very little real knowledge of how much money taxpayers are supplying and seek pay increases that do not take into account the actual cost of the health insurance that is currently supplied.

If you qualify for Obamacare or Medicaid, then you are basically ok with the current system because deductibles and copays are almost non-existent compared to private sector workers and taxpayers foot the bill.

But for the majority of working Americans supporting families, even if you have medical insurance, you hate it.  And here, the failures of the right and left become vivid, like the Grand Canyon.

For the majority of Americans that have health insurance supplied by a private sector employer, the primary problem is cost (+ hassle + anxiety). Your plans have obscenely high deductibles and rising co-pays.  And because the employee costs keep rising far above the rate of inflation, employers suppress the wages of their employees to be able to afford it. So, in exchange for limited medical insurance, we earn less money in each paycheck and have to pay thousands of dollars for preventative and emergency care before insurance pays anything and know that if we suffer from a truly debilitating illness which involves constant medical treatment, our insurance company may refuse to pay anything as a way to lower  and control their expenses.

The Affordable Care Act (the ACA or Obamacare) did nothing to help Americans with private sector supplied medical coverage and in some cases made the cost issue worse.  It is a fact that since the ACA, most Americans are paying more for healthcare plans and those plans cover less medical needs.  

The ACA did expand coverage to millions of Americans who did not have it.  But for smaller businesses and individuals seeking coverage through the same exchanges that sell Obamacare plans, the cost of those plans can exceed half of your total income.

What to do?  

The Republicans have fought to limit, rollback and end the ACA and during this time have not put forward an understable plan to cover all Americans at a reasonable cost to business and the government.  Republicans waste our time trying to pretend that if we could just get rid of Obamacare and indeed Medicare and Medicaid (end government "control" of healthcare), we could all have access to an affordable family doctor seeing patients in a small suburban office with a local hospital nearby, just like back in the imaginary happy world of 1958.

The current progressive dominated Democrats are not much better.  Bernie Sander's idea is that healthcare is a guaranteed and eternal  human right and any person living in the USA therefore has a right to unlimited healthcare on demand from any doctor or hospital they choose.  Moreover, private insurance is forbidden, taxpayers pay for everything and healthcare must be uniformly provided and results must be equal for everybody.  

This is nuts. 

We do not currently possess the national wealth to pay for unlimited amazing health care for everybody.  In that case, Sanders is ok with government rationing, substantial waiting periods for medical procedures and sub optimal outcomes if everybody suffers equally in the process.

What would a centrist plan look like?

• BASIC and limited government supplied insurance coverage of medical and emergency room care for all Americans

• Supplemented by private Insurance sold in a national market untied to any specific employer.

When Bernie cites the civilized industrialized nations in Europe as the model what he doesn't tell you is that they all allow for private insurance to supplement basic government coverage.  And the more the government favors market control (see the NHS in Britain), the worse the quality and timeliness of the care; the more the government strikes a balance (see France) the better the quality, but the lower the access. There is no free lunch or in this case, free health care.

We already spend the money necessary to fund universal basic coverage. The uninsured get medical care now.  Most of it, however, occurs in emergency rooms  and then in hospital rooms when medical issues are at their worst and treatments are the most expensive.   And we pay for it through higher premiums and insurance companies who fight us when we have high bills.

Why would a centrist plan work?  

Hate.

Because Democrats would hate that Americans could still choose higher quality healthcare based on our ability to pay and Republicans will hate that the entire medical industry including doctors, hospitals, pharmaceutical companies and medical equipment suppliers will have to accept some government mandated prices and the right of every American to to be treated in exchange for being able to practice and or operate a medical business in the USA.

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