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America’s Healthcare Conundrum

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America's Healthcare Conundrum

What to do about healthcare in America has been debated for years. Funding has always been a sticking point. Here are a few ideas about that.

As Congress continues to tinker with repealing and replacing the ACA (Obamacare) and the president says he wants a replacement that is not “mean”, the public continues to suffer with arguably the worst healthcare system in the civilized world.

This is not to say we have bad doctors or hospitals. We don’t!  We have the best trained medical personnel and finest hospitals on the planet.  But the delivery of these services, the costs of insurance and the charges to the uninsured, mean that the wealthiest Americans…and of course our members of Congress, the president and our federal judges…get the best care, while the middle class struggles with healthcare expenses, and the poor go without.  The leading reason for filing bankruptcy in the United States is the inability to pay medical costs.  Medical bankruptcy in the richest nation on Earth is a mind-boggling concept.  As is the claim made by people like Newt Gingrich, that healthcare for Americans is not a right, but a privilege. Every other Western Nation provides free healthcare for its people, and even Cuba has a free public system rated better than ours.

The Declaration of Independence states in part that,”…all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”  The Fifth and Fourteenth Amendments both state that “life” is a right, in the context of due process.  How anyone can argue that maintaining health and hence life, is not an integral right for Americans, escapes logic, except to say that some members of the privileged class, like Mr. Gingrich, apparently believe their good health is more important than those of the hoi polloi. Shameful and indicative of  the ongoing class warfare in America.

Another problem with our healthcare is the cost of medicine.  Americans pay much more for prescriptions than people in other countries.  Even the insured, such as myself, are hit with insanely high co-pays for drugs.  We are the only Western nation that does not negotiate with Big Pharma to bring costs down.  The high prices are driven in large part by the major Pharmacy Benefits Managers (PBM’S),  United Healthcare/OptumRx, Express Scripts and CVS Health, who “negotiate” prices for consumers.  However, the more people have to pay for drugs the more these PBM’s are paid for their services by the manufacturers.  Some critics of the system have called this a kickback scheme that rides the fence between legality and racketeering.  Food for thought for Congress.

Along with the costs of drugs are the expenses incurred when doctors, practicing defensive medicine, order needless tests.  Two of the most overused and expensive of these are MRI’s and CT Scans,, when ordinary X-Rays will suffice.  This brings up the issue of medical malpractice lawsuits.  Lawyers in the field have become predacious, filing cases that have little or no merit, in the hopes of squeezing a settlement out of insurance companies.  This drives up the cost of malpractice coverage, which in turn drives medical costs higher for the consumer.

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Medicine is an inexact art and outcomes cannot always be predicted.  On the other hand, numerous studies by the very companies that insure medical practitioners and hospitals, have shown that more than 100,000 Americans needlessly die every year from malpractice by health care providers or hospitals.  So a balance is needed, and that has to come from the courts.  Legitimate case should go forward, while the ones that are clearly frivolous, ought not only be dismissed, but the plaintiffs and their lawyers hit with stiff financial penalties (sanctions) for bringing such litigation.  This too, like medicine, is not an exact science, but steps have to be taken by the courts before legislatures go too far and put caps or other limits on medical malpractice damages that can harm legitimate claimants.

It would be salutary for the Supreme Court to rule that healthcare is a right in the United  States.  You know, like guns and abortion and a lot of other controversial matters.  But I suspect it will be up to Congress and the White House, and perhaps state governments, to fix our healthcare mess before it completely implodes.  I postulate 3 radical approaches this problem.

One is to build a universal healthcare system around Medicare, expanding coverage to all Americans regardless of age, removing the 20% co-pay from services, and providing coverage for prescription medicine.   This would eliminate the PBM’s  and force drug companies to negotiate prices with the government.  How to pay for this?  Well, there are several cabinet departments that serve very limited useful purposes, and whose few legitimate functions can be subsumed by other agencies.  The worst of these are the Departments of Education, Housing and Urban Development, and Homeland Security.

The Department of Education, one of Jimmy Carter’s follies, performs no discernible function that cannot be done at the state and local level.  Education works best when it is tailored to communities and trying to impose a national policy has never worked, nor will it ever.  Billions of dollars are wasted every year by this department, so shuttering it and diverting its budget to an expanded Medicare system, appears logical.

The Department of Housing and Urban Development (HUD) has done nothing but cause urban blight in America. Public housing policies are best determined at the state level and I can’t find anything positive HUD has accomplished since it was established during the Johnson Administration.  Close it and transfer its funding to Medicare.

Finally we come to Homeland Security.  Perhaps the most redundant agency in the government.  It’s composed of a number of law enforcement units taken from other cabinet departments.  Hasn’t made for greater efficiency or safety.  Just a bigger bureaucracy over those of lesser size.  It’s intelligence functions belong with the FBI, CIA and NSA, rather than duplicating what those agencies do or poaching on their respective turfs.  It is the second largest cabinet department, and its creation is one of the biggest mistakes made by George W. Bush.  Return its components to their former parent agencies, and give its budget to Medicare.  For this plan I would also take the Veterans Health Administration of the Department of Veterans Affairs (VA) and move it to Medicare, so that our veterans can get the care they need and deserve, and not have to suffer under the criminal healthcare maladministration practiced by the VA for generations.

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Now I recognize that this is, in effect, socializing medicine, which is a bugaboo to many Americans.  So my second plan would be to privatize this expanded Medicare system and let insurance companies bid for the right to administer it, contracts to be awarded for quality, not cheapness, of care.  Payments to them would be made from the Treasury, finally using our tax dollars in a way that directly benefits the public.  For those critical of these kinds of systems, as so expensive as to precipitate massive tax hikes, I argue that waste and fraud in the federal government amounts to almost a hundred billion dollars a year.  More than enough to provide the public with no-cost, quality healthcare.

We could also legalize and tax marijuana, America’s largest cash crop despite 50 years of warring against a plant that comedian Dave Attell has called, “A Vitamin in Baltimore.”  A few more billions in revenue and maybe we’ll find some significant medical uses for it, once the government stops hobbling research into its potential.

My third suggestion for a universal healthcare system  is to make it a more local mandate.  Let each state craft plans to provide healthcare to its citizens.  Funding could come in part from federal funds and in part from state revenues.  On smaller scales there is just as much waste and corruption in state government as we see federally.  The more efficient states become at rooting out government crime and waste, the more federal funding they should get, in proportion to their population.  As long as every state legal resident is fully covered for healthcare, the federal government need not be involved in the details.  States could do it as a government function or through private insurers, at their option.

Yes I recognize that these plans are controversial, and I fully expect to get plenty of interesting commentary on them.  But I view people who believe healthcare is not a fundamental right, but rather a high margin, high profit business, as heartless to the point of being morally bankrupt.  Regardless, we must do something soon to fix the world’s most costly, least fair healthcare system.  It’s an ethical imperative for a civilized society.

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Martin Schwartz
About Martin Schwartz 11 Articles
Martin Schwartz was a N.Y. police officer, a U.S. Treasury Special Agent (criminal investigator) attached to the U.S. Customs Service, an assistant district attorney in NYC, a special assistant U.S. Attorney in the Southern District of New York (Manhattan) and a special counsel to the U.S. Department of Justice. He is now a writer with prior published work in the N.Y. Times, U.S. News & World Report, U.S.A. Today and Newsday, and a consultant to law enforcement.
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