Members of Congress have no choice, really. They must work within the constraints of what is politically feasible. But ordinary citizens need not, at least not always.
Attempting to free myself from such constraints, I have temporarily put aside all the big-picture proposals currently being discussed, and which I think have merit, like:
• extending health insurance to virtually all of the uninsured—by extending the reach of Medicaid; by mandating coverage, while providing subsidies to very small businesses and individuals with low-incomes; by fining individuals without insurance and employers who do not provide coverage; by taxing health-related products and industries; and by ending the Bush tax breaks for the wealthiest Americans, soon set to expire
• funding comparative effectiveness research, so that research compares new procedures and drugs with each other (not just with a placebo or with one other competitor) and also with current procedures and drugs to determine which work best. It isn’t always the latest thing.
I also support proposed measures to finance the reform, like
• replacing the procedures-based system that Medicaid currently uses to reimburse healthcare providers, with a care-based system—the quality vs. quantity argument. This sounds like an improvement whether it cuts costs or not.
• moving to electronic record-keeping, which would improve the efficiency of care by eliminating duplicative record-keeping and tests, and give a variety of physicians access to the same information. Safeguards for patient privacy and security would also have to be instituted, though, which could add costs unless Congress has already accounted for this in the bill. But electronic record-keeping promises benefits, even if it doesn’t reduce costs by as much as some have suggested.
•setting up a public insurance plan, that is a nonprofit government-run plan, so that consumers would have it as one choice among many private plans, and it could determine what the actual costs of coverage are, what is needed when and where, and serve as competition for private companies. Right now, there are only a handful of major insurers in some areas of the U.S., which makes choice of insurer very limited. As for a cooperative mix of for-profit and non-profit plans that are not run by government, why not have that as well—only without government subsidies, since the argument against the public plan is to keep government out of private business.
Meanwhile, however, perhaps as a frustration-coping device, I have begun to wonder what I might propose if anyone asked me (unlikely). Brainstorming requires the freedom to consider even the wackiest, most implausible ideas. My contention is that if enough citizens seriously engaged in it, someone—perhaps an America reader—might come up with an idea that is both helpful for reform and feasible, and which is new and worth broadcasting. The real crux is paying for reform—something the general public seems less and less willing to do. So please offer your own wild ideas on that topic in the comment space.
Three wild ideas for financing the reform:
1. A sugar tax: Yes, this notion comes to you from a perennial sweet tooth, and it builds on a proposal that has already been considered publicly as a health-related way of paying for the reform, a tax on sugary soft drinks. Some critics of that notion asked, why us? why would soft drink makers be saddled with such a tax? Hmm, I thought. They’re right. Why not extend the scope rather than throw out the idea completely. Why not levy a small tax on every product (from candy to breakfast cereals to soft drinks to wine—every food) that contains sugar above a certain percentage or that exceeds set amounts. Or it might be structured so that the more sugar an item contains, the higher the tax. Some qualified team of physicians and nutritionists, for instance, could work out reasonable, health-based standards, and legislators could fine-tune the details.
If every consumer paid something small (a penny per item, say—six cents on a pack of soft drinks or a box of chocolates), the money raised would go directly into the government’s revenue stream for health care. We would get the money back in services and benefit from better, more extensive care and coverage. This little tax would earn money year after year, even as it raised public awareness of the health dangers of too much sugar and, one hopes,
The Reason: while sugar in moderate amounts is not harmful to health (any more than liquor or alcohol is), many products contain quantities of sugar that make it a prime contributor to rising diabetes and obesity, which are enormous health concerns, and increasingly so for children. Or the products are consumed in such quantities that they become a health risk. We have a liquor tax and a cigarette tax to help combat particular ill-effects, why not a sugar tax designated solely as revenue for health care?
2. A health bandwagon: The government wouldn’t have to initiate this bandwagon, but it could. Or it could just augment the work of other groups and individuals. If you are old enough, think of the “President’s Physical Fitness” program that John F. Kennedy sponsored in the sixties. Or of private groups like Weight Watchers, AARP, health clubs, product sponsors and advertisers, as well as church and civic groups—all of which could promote in a new way, with a national focus on health, “healthy habits” like a health eating and exercise. A new bandwagon is an idea anyone or any group could run with, promoting creative ways of involving parents, children, teachers, seniors, and all other Americans. And it could involve millions, inspired to get on the bandwagon.
Since childhood obesity is on the rise and can turn into diabetes and a lifetime of illness, it should be one of the first issues addressed. Something for Michele Obama to stand behind? Or some child stars?
The trick would be to keep such a campaign positive, lest public sentiment turn negative against the overweight, the ill, or the old. The idea would be for each American to “do something more,” to take personal responsibility for prevention of disease and to improve their health—whatever it is. Those who are ill or suffer a chronic condition would merit society’s applause, and improved health, by doing all they can to lessen the ill effects.
The Reason: This program would focus on societal good. Getting in better shape would be seen as a patriotic act, not merely as good for each individual. The population would be respectfully invited and encouraged to do its part to improve the nation’s overall health and fitness, getting ourselves “in better shape.” That would be a boon if it could motivate citizens to take responsibility for constructing the society we want to live in. The long-term rewards: generations of healthier Americans more active in constructive government.
3. Add a line to the federal IRS form—a little box taxpayers could check so that $1 from one’s tax refund goes to health care. I’m not kidding. I realize that there are zillions of important and worthwhile causes that taxpayers could support and that dozens of charities are facing hard times in this distressed economy. But health care is a national priority that begs for universal support. I even realize that opponents of the reform are balking at the costs, to the point of denying the need for reform, despite all the evidence that shows it is imperative. Putting a “gift” option on the form would raise some money, without costing much of anything. It would also extend our role as stakeholders, perhaps the more important reason for doing it.