Responsibility #87

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="04900840erlcjm.png"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>NATIONAL SECURITY--Structural,Moral,Economic,Domestic,International</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="NATIONAL SECURITYStructural,Moral,Econom"><U><B>home</B></U></A></div> <div> <A HREF="id33.htm" TARGET="_top" TITLE="Responsibility Contents"><U>Responsibility Contents</U></A>   |   <A HREF="id34.htm" TARGET="_top" TITLE="Responsibility 1"><U>Responsibility #1</U></A>   |   <A HREF="id35.htm" TARGET="_top" TITLE="Responsibility 2"><U>Responsibility #2</U></A>   |   <A HREF="id36.htm" TARGET="_top" TITLE="Responsibility 3"><U>Responsibility #3</U></A>   |   <A HREF="id37.htm" TARGET="_top" TITLE="Responsibility 4"><U>Responsibility #4</U></A>   |   <A HREF="id38.htm" 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President, et al,"><U>Health Care Letters to President, et al, 8/24/94</U></A>   |   <A HREF="id123.htm" TARGET="_top" TITLE="Arguments for Delay in Enactment of a He"><U>Arguments for Delay in Enactment of a Health Care Bill</U></A>   |   <A HREF="id124.htm" TARGET="_top" TITLE="Post WORLD WAR IIPost COLD WAR Deja Vu"><U>Post WORLD WAR II--Post COLD WAR Deja Vu</U></A>   |   <A HREF="id125.htm" TARGET="_top" TITLE="Responsibility 89"><U>Responsibility #89</U></A>   |   <A HREF="id126.htm" TARGET="_top" TITLE="Responsibility 90"><U>Responsibility #90</U></A>   |   <A HREF="id127.htm" TARGET="_top" TITLE="Responsibility 91"><U>Responsibility #91</U></A>   |   <A HREF="id128.htm" TARGET="_top" TITLE="Responsibility 92"><U>Responsibility #92</U></A>   |   <A HREF="id129.htm" TARGET="_top" TITLE="Responsibility 93"><U>Responsibility #93</U></A>   |   <A HREF="id130.htm" TARGET="_top" TITLE="Responsibility 94"><U>Responsibility #94</U></A>   |   <A HREF="id131.htm" TARGET="_top" TITLE="Responsibility 95"><U>Responsibility #95</U></A>   |   <A HREF="id132.htm" TARGET="_top" TITLE="Responsibility 96"><U>Responsibility #96</U></A>   |   <A HREF="id133.htm" TARGET="_top" TITLE="Responsibility 97"><U>Responsibility #97</U></A>   |   <A HREF="id134.htm" TARGET="_top" TITLE="Responsibility 98"><U>Responsibility #98</U></A>   |   <A HREF="id135.htm" TARGET="_top" TITLE="The Structure of Our Nation is Unsound"><U>The Structure of Our Nation is Unsound</U></A>   |   <A HREF="id136.htm" TARGET="_top" TITLE="Ltr. to Editor, 3/19/96, Property Taxes "><U>Ltr. to Editor, 3/19/96, Property Taxes and Education Funding</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#CCCCFF" TEXT="#080000" background="04311c00egdysm.png"> <bR> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Responsibility #87</div> <div> To the People of the United States of America:</div> <bR> <div>      <U>6th postscript, April 1994</U>.  So back to the drawing board, before reproposing a universal Health Care plan.  The complexity and high risks, associated with the health care issue, make it analogous to that of a replacement major defense or space system.</div> <div>  </div> <div> 1. First we set mission or top level requirements.  The quality of health care now available is not to be compromised.  Universal coverage shall be attainable for all citizens and legal residents.  Coverage shall be transportable from job to job (and in unemployment), as well as geographically within the USA, with limited or no increase in costs.  The system shall meet the requirements under the Constitution for justice and <I>"property rights".</I>  Consistent with these requirements, the system should maximize the ability for costs to be controlled, overall for the nation, and individually by individuals/families.</div> <div> 2. Price controls have proven ineffective, and unjust, when they have been employed by the federal government.  Therefore the proposed medical cost caps in the Clinton plan (et al) are ill advised.  The nation and the world will benefit from the continued encouragement of research, development, testing, and innovation by medical and pharmaceutical firms.  Those firms will of course seek to recoup, and profit from, the economic and legal risks they have taken.  We must rely on supply and demand in the health care market place to hold down prices.</div> <div> 3. As discussed in earlier RESPONSIBILITY papers, the attainability of universal coverage can best (perhaps only) be achieved through the reverse direction, from the Clinton (et al) plan.  To wit, health insurance policies must be based on the universe of individuals, not company or other buying groups.</div> <div> Economies of scale (for marketing, administration, customer retention, etc.) cost reductions can certainly be continued to be passed on to buying groups.  But the dominant premium determinant, insurance rating factors, must be based on the universe of individuals (about 250 million strong).  With mandatory universal coverage, and with the "configuration" of the elements of the health care system as envisioned in these essays, the differential costs of marketing and administration (and, perhaps, retention) will prove to be even less significant.       </div> <bR> <div> 4. Essentially universal coverage entails an individual (or readily convertible) policy, even when the insured is a member of a company or group purchaser.  When leaving the company or group, yet staying within a geographical area where both the insurer and his authorized health care provider(s) functions, the insured needs only to adapt to some procedural changes, and possibly pay some small additional premium.  If in the move, the insurer is chartered in the new area, but his authorized health care provider(s) or the local economic factors are different, limited adjustment in premiums may be appropriate.</div> <div>  </div> <div> To assure complete transportability, yet permit the greatest degree of competition among insurance companies and among health care providers, a (innovative) policy rider would be required on all policies.  In the case of insurance companies chartered in all states and insuring in all localities, the rider would purely document the agreement that upon insured's relocation, the policy could be converted into the available coverage most like that being replaced.  For insurance companies with more limited geographical operations, a co-insurance rider would have to be negotiated with a "full geography" insurance company, obligating the latter to cover the contingent situation.  Like the basic policy, the contingent rider portion of the premium would be based on the insured's insurability factors.</div> <div>      </div> <div> 5. Let us face it, a principal reason our health care costs are out of control, and we have such a mess in the overall system, is that We the People let (yea encouraged) our Congresses, our Presidential Administrations, and our Courts, violate the Constitution time and time again.  </div> <div> In order to buy the support of the American Medical Association, for the initial passage of the Medicare act, the politicians assured the AMA that the government would pay all charges submitted by the industry (a blank check).  But when costs were seen as too high, or needed to be reduced due to budget deficits, by fiat (a la the Clinton plan caps) or by disallowance of cost claims administratively, the care provider was forced to choose between "eating" the "excessive" cost or passing it elsewhere (i.e., to patients covered by private insurers, or to the uninsured).  A similar situation prevails with other government controlled programs (Medicaid, military Champus, The Federal Employees Health Benefits Program, etc.). </div> <div> Violations of the Constitution, with respect to company health care programs, began right after unions "invented" these alternative remunerations for the labors of its members during World War II.  The IRS declared the benefits paid by the employer a company tax deduction like wages, and tax exempt to the employees unlike wages.  All income tax payers had to <I>"have private property be taken for public use, without just compensation"</I> to make up for the individual taxes not collected on this alternative form of wages of the covered employees.</div> <div> This situation was somewhat alleviated, but more compounded, by the enactment of income tax deductions, for uncompensated medical insurance premiums and expenses.  Like all tax deductions, the Congress at will played havoc with the medical deductions (allowing, disallowing, lowering thresholds with respect to adjusted incomes, etc.).  Certainly <I>"justice"</I> was not established by the forced subsidy of one taxpayers' health care by other taxpayers, and was a compromise of <I>"property rights".</I></div> <div>   </div> <div> Subsidies came into greater play with Medicare.  Similar to Social Security, basic Medicare benefits are paid from payroll taxes levied on employers, and all wage earners.  They are not a function of how much the recipient had paid in Medicare payroll taxes, while a wage earner.  Therefore greater earners and longer time paying earners subsidize others' benefits.  An individuals' insurability factors also play no part in setting the amount of these "advance premiums", which the payroll taxes constitute. This is a departure from insurance principles; it is therewith a subsidy from some to others, a violation of <I>"property rights".</I></div> <div>   </div> <div> Finally, the optional insurance premium, paid by those on Medicare who elect to be covered, is not a function of individual insurability factors.  It has been reported in the newspapers that Medicare participants pay only 1/4 of the premium; 3/4s is subsidized out of general income tax revenues.      </div> <div> Obviously all these injustices (<I>"property rights"</I> violations) must be avoided, in the forthcoming Health Care legislation.</div> <div> 6. America proclaims to the world, its belief in the free enterprise system.  Then when it steps forward to meet such challenges as assured income for those in retirement, health care for the elderly, and now universal health care, our politicians avoid the individuals' responsibilities under free enterprise, and falls back on socialistic/communistic principles.</div> <bR> <div> As argued throughout these RESPONSIBILITY papers, the nation can only solve its problems, by insisting on individual responsibilities.  An individual or family should continue to have the responsibility, to assure its adequate and continuing health care.  If there is to be a mandate, it should be on the individual and family.  The nation certainly has more than sufficient reason to lay on this benefit and burden, especially when concurrently the nation promises to provide a safety net for any of those who are (or become) poor and near poor.</div> <div> The creed (and general experience) of the free enterprise system is that quality and cost control can best be assured, by allowing the fullest participation in the market place.  Thus health care legislation should be built on insurance from localized companies to nationwide titans.  Health care providers from sole practitioners to all variations, sizes, and geographic extents, of group practices, managed care organizations, clinics, et al, should not be barred and (minimally inhibited) from qualifying to meet the quality and cost criteria of the insurance companies.</div> <div> As discussed in a previous paper, the choice and control of costs of medical insurance, by individuals or sponsors, can best be achieved through the definition of a minimum standard, and a small number of standard optional policies.</div> <bR> <div>      A number of subject updates, yet to be treated in this 6th postscript, interrelate with and have an impact on Health Care.</div> <bR> <div>                     Publius IV</div> <bR> <div> <A HREF="id121.htm" TARGET="_top" TITLE="Responsibility 88"><U>Responsibility #88</U></A></div> <div> Back to: <A HREF="id33.htm" TARGET="_top" TITLE="Responsibility Contents"><U>Responsibility Contents</U></A>    </div> </td> </tr></table></body>