A modest proposal to keep the nation healthy, solvent


November 28, 2012 - 12:00 AM

President Barack Obama is going about the country drumming up popular support for raising taxes on the rich to avoid falling off the notorious fiscal cliff. It is doubtful that the poll numbers he generates will convince his Republican adversaries.
The president won the opinion poll that matters on Nov. 6. His re-election and his popular vote majority showed that the people agree with him on fiscal policy.
That’s not surprising. The targets of the president’s tax hikes represent only 10 percent or fewer of the population. One would expect the 90 percent to be willing to allow the 10 percent to pay more taxes.
But as Senate minority leader Mitch McConnell observed, unless health care costs can be brought under control and reduced, taxes can’t be raised fast enough to allow deficit reduction. Medicare and Medicaid must be on the table, he said.
Those two massive federal programs amount to a fifth of the federal budget and insure one-third of all Americans. Because the country keeps growing older, and the cost of health care keeps rising, the amount the federal government will spend taking care of the poor and the elderly will grow faster than federal income — unless one or both of the elements in this equation are altered.
Sure, revenues should rise. It is preposterous that so many of the very rich pay such a small percentage of their income as federal taxes. Federal income from taxes is at a 62-year low as a percentage of the gross national product. That percentage must rise if federal income is ever to match federal spending. It is a pernicious myth that the U.S. is a high-tax nation.
It is equally obvious that health care costs must be brought down. The U.S. spends about 17 percent of its GDP on health care. Canada comes next at about 11 percent — and Canada has universal health care while the U.S. has about 50 million uninsured.
But here’s the sticking point. U.S. costs are the highest by far because so much is spent on administration — mostly on insurance — and health care providers are given such generous payments. Health care costs should be reduced from the top down. All Americans should receive excellent health care. But those who provide that care should be rewarded less generously — starting with the health insurance companies and their million dollar executives.
This is the message the president should take to the people. He should say he will reduce the costs of providing health care to all of the people by restructuring the system, using as models Canada and the other nations which long have had high quality universal health care systems at affordable costs.
Doing so, he should tell the people, will be the fastest, least painful way to reduce federal spending and bring the budget into balance.

TWO LIBERAL senators, Tom Harkin of Iowa and John D. Rockefeller IV of West Virginia, said in a letter to Mr. Obama that he should “reject changes to Medicare, Medicaid and Social Security that would cut benefits, shift costs to states, alter the structure of these critical programs, or force vulnerable populations to bear the burden of deficit reduction.”
Harkin and Rockefeller are right. Health care reform doesn’t need to reduce the amount or level of care provided to the people. Shifting costs from the federal government to the states is no reform at all.
Root and branch restructuring is required.
Obama should devote his second term to calling for and achieving this fundamental change in the way health care is provided and paid for in this wonderful nation we have built. That magnificent accomplishment would assure him a place among the nation’s most effective presidents.

— Emerson Lynn, jr.

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