Congress should create a Federal Healthcare Authority (FHA) to reform and oversee the nation's healthcare system.
Unfortunately, healthcare reform is not as much about health as it is about money. But that is the reality of it.
The public debate around universal healthcare has centered on reform. However, the key to achievable universal healthcare is restructuring the healthcare system, which is much more comprehensive than mere healthcare reform.
The question is not if, but when and how, we will adopt universal healthcare.
Obama could use universal healthcare as one means for defining his legacy, but the legacy value is in the how rather than the if. I propose that Obama use universal healthcare to reinvent the STRUCTURE of the economy; this is the how.
Obama could model a single-payer healthcare system after the Federal Reserve, with a Board of Governors, etc. In addition to serving as a a centralized place for receiving and issuing payments, a Federal Healthcare Authority could generate considerable income from short-term investments using the money running through this system, a cost savings of $100-$125 billion annually (perhaps much more).
Thus the Federal Healthcare Authority would become a shadow banking system not unlike a second Federal Reserve because of its magnitude, processing a minimum of $1 trillion annually, and probably a figure much higher.
All healthcare activities, public and private, would be regulated under the Federal Healthcare Authority, whose single systemic regulator and Board of Governors would be empowered to set standards of care and pricing.
The majority of Americans already have health insurance. However, possibly as many as forty million do not. Universal healthcare is not universal until everyone is covered.
The government has proposed a "public option", which it defines as a government-run plan to cover those millions not already insured. The government thinks its plan would compete with private plans, driving down the costs of healthcare.
Critics of the public option fear that the private sector cannot compete against government healthcare because of the government's access to virtually unlimited funding.
I agree with the critics. Government intrusion into direct delivery of healthcare services would likely narrow patient choices and lower the overall quality of healthcare.
For this reason I am also not in favor of co-opts.
There should be no government-run plan to compete with private plans in order to theoretically drive down costs. I would preserve the public's right to choose their own private insurance plan at public expense.
The government should fund the inclusion of the qualified uninsured into private insurance plans. Instead of posing a threat to the viability of the private sector, the correct government reforms would give companies an economic shot in the arm. However, the Federal Healthcare Authority (FHA) would be empowered to set standards of care and pricing.
Revenues to cover the uninsured would be drawn in part from the surplus income from short-term investments using the money running through the FHA system.
NO NEW TAXES
It is fundamentally unjust to propose that the rich be targeted and involuntarily
assessed to pay for the poor.
Advocates of universal healthcare frequently construe healthcare as a human right. Although I view universal healthcare as an expression of the social conscience rather than a divine right, I would raise a counter-balance, suggesting that with rights come responsibilities. For example, we all bear a social responsibility to combat communicable diseases, not alone for ourselves but for the good of the whole.
If we insist on universal healthcare, then it must be mandatory in order to be universal. Mandatory healthcare includes "accessibility of coverage"; no one can be denied coverage because of a pre-existing medical condition. But in order to achieve parity of coverage for all Americans, we must adopt the reasonable worldview that the rights of the individual are not unlimited. We must understand that the rights and responsibilities of the individual must be weighed against those of the insurer and the government.
Furthermore, in an increasingly globalized world, the reasonable rights and responsibilities of the international community must also be considered. The current H1N1 pandemic will likely test the resolve of responder systems in balancing individual rights and social responsibilities.
ELEMENTS OF OPPOSITION
So who would oppose such a natural undertaking in social evolution? There is always a segment of people who are anxious about change, but this class is less resistant than those who have a material interest in maintaining the status quo.
As stated from the outset, healthcare reform is not about health as much as it is about money. There are those who stand to lose a portion of their profits. From these, I want to discuss two groups:
1. Healthcare is annually up to a two trillion dollar industry. Doctors, for-profit hospitals, and insurers are invested in the healthcare industry.
2. The banking industry and the Federal Reserve may view the Federal Healthcare Authority as a threat because for all intents and purposes it would become a major competitor to them in the arena of finance and credit.
Wall Street, the latter of these two groups, is certainly the most formidable. There is a fundamental moral disconnection in the notion of profiting from the misery of others. Non-medical practitioners would be more inclined to do so.
HEALTHCARE AND THE LIFE CYCLE
A natural framework for healthcare may be found in the human life cycle. I propose rendering services as follows
1. From birth until age 18, services should be provided at public expense through the schools, with an emphasis on preventive care. Through the schools, the federal, state, and local governments would maintain a partnership in funding and delivering medical services.
2. From age 18 to Medicare retirement age; i.e., working age, coverage should be supplied primarily by employers. The Federal Healthcare Authority would buy private coverage for those who cannot afford it.
3. After Medicare retirement age, the federal and state governments would continue to provide medical insurance through Medicare and Medicaid. Further reforms, such as extending the age of Medicare eligibility, would have to be considered by the Federal Healthcare Authority at a later date.
So the natural cycle of healthcare is not so different than the current healthcare delivery system. The biggest difference relates to funding, the burden of which is borne by the federal government as an outcome of adopting the Federal Healthcare Authority restructuring plan.
The federal government should get out of the business of the DIRECT delivery of healthcare services. Instead, the government should act as facilitator at the level of policy and finance.
In keeping with this philosophy, the government should divest itself from managing veteran care under the Veterans Administration by transferring the VA facilities and patient care to the private sector. Selling assets will raise needed revenue.
While VA care has been often admirable, transferring care to the private sector will likely enhance the quality of services and lower costs to the government associated with maintaining land and personnel and delivering direct services.
POLITICS AND PRACTICALITY
The current debate has exposed the political weaknesses of Washington. Much of the public outcry is justified. The sticking point is "reform". Congress cannot possibly negotiate the complexities of national healthcare in a single bill to the satisfaction of all their constituents. Hence, a 1,000-page bill that no one understands, not even the members of Congress. Continuing on the "reform" course is political suicide.
For this reason, I propose restructuring national healthcare rather than reforming it.
The primary issue in healthcare is money.
In the current debate, it is important to distinguish the meaning of terms like "public option" and "single payer". My notion of public option is a program government funded and privately operated. The single-payer healthcare I envision works because it creates its own revenue stream.
Under my proposal, all healthcare providers would register with the Federal Healthcare Authority, with the advantage that all healthcare activity would be electronically tracked and abuses made transparent. Electronic tracking would be a necessary element of a single-payer system in order to justify payment for services.
"No-abortion" clause. Under reform, the funding of abortion should be in consistence with current law.
Even if authorized, the Federal Healthcare Authority would not be viable before perhaps 2012.
Irrespective of partisanship, all politicians agree that the status quo in healthcare is not viable. Medicare will exhaust its funding in ten or so years, right as the generation of Baby Boomers comes of term for coverage. The numbers do not compute so we face an unfunded liability. And this is only one aspect of the healthcare crisis, which is contributing to the onset of an unsustainable economy.
Congress risks meaningful progress toward universal healthcare so long as they banter over reform. Change to the healthcare system must be structural.
Congress should focus its attention on passing a bill authorizing the creation of a Federal Healthcare Authority (FHA). The FHA can them sort out the details of healthcare reform.