Tuesday, March 30, 2010


The nationalization of health care in America has become the most divisive political issue in my memory.

It virtually defines the right and the left, liberals and conservatives, Republicans and Democrats.

It divides TV channels, friends, families, even husbands and wives.

Case in point. My good friend, Ernie Phillips confesses being totally confused by the arguments of his two, intelligent, passionate brothers who come at him from opposite sides of the issue.

Like Ernie, I have a disposition toward peacemaking. Thus this effort to look for common ground.

To begin at the beginning, I pose the question, who should pay for health care?

For the moment. let's leave the question of affordability out of it.

The question is, in a perfect world, who has, or should have he legal and moral responsibility to pay the doctor, the nurse, the druggist and the hospital?

Here's a list of possibles: the city, the county, the state, the federal government, the insurance companies, the patient, the parents, the children, the grandparents, the grandchildren, the neighbors, the church, the rich, the middle class, the employer, the taxpayers, the Chinese.

OK, I wasn't serious about the Chinese. Just trying to keep the discussion light hearted.

I suspect that both sides would agree that the patient is or should be the primary source of payment for his or her own health care.

Conservatives might then say, "Case closed. Let the free enterprise system take it from there."

Liberals, of course, will reply, "Wait a minute. What if the patient can't afford to pay?"

Ok, let's assume the patient can't pay. Take the patient (and the Chinese) out of my list of possibles, and ask the question again.

Who has, or should have the legal and moral responsibility to pay for health care, if the patient cannot?

The first answer that comes to mind, and probably most folks, regardless of political persuasion would agree on this, is "It all depends."

Are we talking about a new born baby? A college student? A ninety year old? A wounded veteran? A policeman or fire fighter injured in the line of duty? Victim of an earthquake, hurricane or tsunami? Or of a nationwide epidemic?

Should it matter that the patient's malady stems from voluntary causes? The obese patient with diabetes or heart trouble? The helmetless motorcyclist? The smoker with lung cancer?

Our churches and our humanity teach us that all people have obligations in charity. To feed the hungry, to shelter the homeless, to heal the sick, to comfort the afflicted, to teach the young, to help the poor, to defend the weak, to bury the dead.

But leaving the health care of the needy to private philanthropy would not satisfy even the most conservative precincts. Someone has to decide who takes care of those who cannot take care of themselves.

While most folks agree on that point, they part company on the question of who should make those decisions.

For over 200 years in America, health care has been dealt with by state and local governments. Doctors, dentists and nurses are licensed by the states; cities and counties have established hospitals. Health insurance providers have been regulated by state laws and state insurance commissioners.

It has long been assumed that health care comes within the residue of state sovereignty protected by the tenth amendment. Our constitutional founders intended to leave state governments in full control of the health, welfare and safety of their citizens.

Even the most ardent conservative will have to concede that if a given state wants to enact a system of socialized medicine, it would have the perfect right and power under the constitution to do so.

That is one of the great strengths of our federal union; the states can experiment. If the people don’t like it, they can move to a state which is run more to their liking.

Nationalized health care deprives the states of their power to decide who pays the doctor, and takes from all Americans of the freedom of choice which the founders intended them to enjoy.


  1. I guess you don't believe the NTSB,FAA,etc should exist. We are the only industialised western country that does not have universal health care. If we decided to stop our outrageous spending on the military we would have no problem paying for it. We will end up with at least two trillion dollars of debt for the Iraq fiasco. I suppose you don't except your medicare benefits or social security if you are being consistent. This is a moral issue.

  2. Hmmm... The NTSB and the FAA do not mandate that I participate, but simply govern the rules of travel if I choose to expose others to my privilege of driving or flying. Our fedral government was designed to guarantee our freedom of the pursuit of happiness, not to guarantee our happiness. What's next? Guarantee a roof over my head? A car in my garage? The "right" to a job?

    The country was founded and excelled on the possibility of success and the motivation of failure. "the land of opportunity" not the land of entitlement.

  3. I suppose you are in favor of the repeal of medicare and medicaid which are classic entitlement programs. Throw in social security as well. Also why not do away with public education which uses my tax dollars to pay for it despite the fact that I have no children in the system.

  4. G Man misses the point. The US is the only western (or eastern) country that is a union of sovereign states.The National Transportation and Safety Board and the Federal Aronautics Administration have their genisis in the regulation of interstate commerce, a proper federal function. But the constitution does not contemplate the nationalization of health care.

  5. The real gist of health care reform is to expand and deepen the existing federal tax subsidy for insurance by not only making it more attractive to some firms, but actually punishing firms that do not partake.

    Are mandates the best way to fund this expansion? Probably not. I would have preferred a single-payer catastrophic plan funded by an employer-based levy - with an opt-out for employers who provide a more generous plan for employees. Additionally, employers who are more generous to their retirees than Medicare should be able to opt out of the Hospital Insurance Tax (which could be expanded to fully fund Medicare's future obligations as well as long-term care Medicaid costs).

    Medicaid should be reformed to be more like Medicare, since too many doctors opt out. The reasons they opt out should be repealed, since the wait times for program participants put Canadian health care to shame. The biggest reform for the working and non-working poor would be mandatory sick leave, since only that would get patients out of the emergency room and save costs.

    To supplement catastrophic insurance, there should be employer funded Health Savings Accounts and patient funded Flexible Spending Accounts (which would fund items off the approve list, such as accupuncture and abortion, as well as all copays).

    Of course, the big problem with the debate was the unwillingness of one side to take any ground on the condition of voting yes. The Republicans were dealing in bad faith to use the issue electorally and ended up participating in Kabuke theater funded by the Health Insurance Industry. The process and its participants were badly used. Indeed, the anger quotient went up for no reason but to solidify that industry's bargaining position vis-a-vis the public option.

    The severability clause in the legislation will actually make repeal impossible, since if mandates are repealed, they will simply trigger the demise of private insurance and lead these companies to the TARP window, which has enough authority to create a single-payer plan or a robust public option (killing the non-TARP plans) without a law being passed.