Saturday, July 11, 2009

The Rich Must Pay More Taxes if Everyone is to Have a Right to Health Care

Cross-posted at Now Public, the Francis L. Holland Blog, and Public Option Health Care Now.

It's absurd to argue whether the US should have a public option health insurance or not. The real question is whether the for-profit insurance companies should have a captive audience or not.

The US already has public options for many people, but on a smaller scale than is necessary through the Community Health Service and the Veterans Administration Hospitals. I think the Government should rename the VA "The Veterans and Patriots Hospitals", make the hospitals available to all Americans - not just veterans.

To meet the increased need for services, the Government should purchase underfunded hospitals that have been closing in inner cities and rural areas, reopening them to serve anyone and everyone who presents with a health need.

Is this "big Government". No, it's "sufficient public health care" for a nation with a population of three hundred million people and growing. Anything and everything designed to meet the needs of a third of a billion people will inherently be big and to pretend otherwise is quaintly foolish and silly. New York City has 39,000 police officers and 11,000 firefighters, but I don't hear anyone complaining about "big government police and fire services," except those who would prefer that their houses burn down.

The deparments are big because they serve a city with over eight million residents. I would certainly hope that if Republicans ranted against the big police and fire departments of New York then residents would ask these politicians if THEY would like to put ouf the fires and make the arrests themselves.

If we want extra around-the-clock security, then we each can buy that. But, we all have a right to police and fire protection without paying a separate premium for each of these services, and now what we need is a right to health care as well. Lord help us if the first person we talk to when we call the police or fire department is an insurance adjuster who wants to know if we're covered or not.

So much money and bureaucracy would be saved by making health care a right and making its provision a collective national duty, as it is in Brazil. It would be less expensive if only because the Government wouldn't need hordes of bureaucrats for means testing and other hordes to collect individual premiums.

I'm frankly disgusted to hear politicians wanting to "mandate" that individuals buy insurance, as if individuals don't want to be insured. That's like mandating that people individually purchase access to police and fire deparments. Is there anyone who doesn't want the police and firefighters to come when their called? What individuals don't want is to have to go out and each pay bribe to police officers and firefighters in order to access these services. They don't want to pay individual premiums that they know they can't afford.

Meanwhile, police and firefighters don't want or need the responsibility for "point of service" fee collection. A system like that would prevent these public employees from doing the jobs that they're paid to do.

Individual mandates are absurd. If individuals refuse to assume five hundred dollar per month payments, what is the Government going to do? Send the insurance police out to get them? Oh, that will be VERY popular! If they don't have insurance, one very reasonable explanation is that they simply cannot afford it. Ridiculous discussions of tax breaks for individuals are like tax breaks so that people can pay for fire and police protection. Just the collection of such taxes would double the cost of the service provided.

Insurance companies would LOVE such a mandate, particularly without a public option, because then insurance companies could jack up their rates even more, with all of America unable to leave the used car lot without buying one of the crummy used cars.

We already have a way to get money from people for health insurance based on their ability to pay. It's called the IRS. Because we already have the IRS to collect taxes based on ability to pay, we have no need to create an entirely new bureaucracy for determining and collecting individual health premiums. And our society does not need the transaction costs involved in each of three hundred million Americans selecting insurance from among dozens of incoherent and incomprehensible "options". What people need is the assurance that their health needs will be met regardless of what they are, with no deductibles, co-pays, or yearly limits.

I'm so glad to hear Charles Rangel, Chairman of the House Ways and Means Committee finally coming to his senses and discovering that we mut pay for health insurance for all by taxing the rich as we did before the series of Reagan/Bush tax cuts. That was always the obvious solution.

We may all remember when, shortly after the election last year, Obamacrats announced they would not increase taxes on the rich now and would wait for absurdly generous tax breaks to expire in 2011. With this pronouncement, Obama put himself unneccessarily in a box early on - a box wherein the money for national health care could only be found by new taxes on the working poor and the middle class.

Health insurance became unworkable on that day and only now is being revived with the realization that people who have gotten rich in America must help to pay for the health care of those who have not. That's the way it works in Brazil. If that were not the case, then Brazilians would not all have the assurance that they can go to a doctor, hospital and pharmacy as the need arises.

Monday, June 29, 2009

Can the US Provide Free, Public Medical Care Like Brazil?

Free public neighborhood health clinic in Brazil
where treatment is provided to all
as fundamental right.

I am not convinced that single payer is necessary to dramatically improve health care in the US. I believe that making health care a right (like the right to vote) - a right that is not means tested - is what we really need.

This morning in Brazil, I went to a Government public health clinic in my neighborhood, made an appointment to meet with a doctor tomorrow morning for a consult and prescription, and I will be charged $0.00 (zero) for this service, because health care is a right in Brazil.

I showed proof of address (because people must go to the health clinics in their neighborhoods - the clinics that are closest to them) and I showed proof of my identity (incidentally as a foreign permanent resident). I also showed proof that I am up to date with my vaccinations, which are provided for free at the same clinic. Tomorrow when I get the prescription, the medications will be provided for free.

There's still one question that an American really wants to ask here: Where's the cash register? At these clinics, there are no credit card swipers, cash registers, and no calls to any insurance companies or Government bureaucrats to confirm whether the patient is covered for one service or all services.

national health care,medical insurance,socialism,physician,medicine,free,public,appointmentAlign Center

At seven in the morning,
patients line up to schedule appointments
which may be from a day to a month away.

Crucially, there isn't even a check within Government records to confirm a patient's right to be served. Since Government-provided health care is a right for all that is not means-tested and is provided by the Government itself, there's no need to confirm people's insurance status. Health care is actually more of a right in Brazil than voting is a right in the United States, because there is no need in Brazil to show that you have "registered" to participate in the free services. And there is no crime a person can commit that would result in the loss of the the right to participate in the Government system.

The existence and operation of the free health clinics, hospitals and blood work laboratories is Brazilians' "insurance" that health care will be available to them. The government buys or manufactures medicines in bulk and provides them for free, either at this clinic or at the hospital downtown.

While waiting in line to schedule an appointment this morning, an elderly woman mentioned in passing that, in addition to having a home in this town, she also owns a summer cottage and land in the countryside. It doesn't matter here. Yet, if she said the same thing at a Medicaid office in the US, she would probably carried out by armed guards, tasered and/or arrested and charged with fraud.

And yet, even with the absolute guarantee that patients have a right to Government health care through this nationwide system of free clinics and hospitals regardless of income, assets or ability to pay, (some people sue the Government for failure to provide expensive care or new and expensive medicines for unusual conditions) there are still private insurance companies, doctors and hospitals for people who have conditions for which the state system isn't equipped to provide excellent and immediate care, and/or for people who want the "Cadillac" service that we really all should get wherever we are.

To make health care more affordable in the US, setting up a national system such as the one in Brazil, or in the Seattle / Puget Sound area, where all of the medical, nursing and administrative staff work for salary rather than as entrepreneurs, is the surest way to keep costs down. Along with doing away with the bureaucracy involved in means testing, charging individuals for insurance, making sure that they have paid, etc.

The crucial part is not that Government nationalize all medicine, but that Government set up a national system Government-owned clinics hospitals and pharmacies like the system Brazil has, or provide insurance to all Americans the way the French do, with patients accessing services from private providers and the Government paying for these services.

Wednesday, June 24, 2009

Francis L. Holland is a Socialist!

My Own Personal Socialist Manifesto
  1. Like President Daniel Ortega of Nicaragua, President Fidel Castro of Cuba and President Hugo Chavez of Venezuela, Francis L. Holland is a socialist. Francis L. Holland believes that everyone who passes the medical school entrance exam should be provided a free and public education, just as was the case in Nicaragua under the socialist Sandinistas in the 1980's, and continues to be the case in Cuba today. So, Francis is a socialist.
  2. Francis L. Holland believes that all children should be offered a free, public and equal education. As such, he believes in socialized education, although he certainly hopes the United States will not stop offering free and public education simply out of ideological opposition to socialism.
  3. Francis L. Holland believes that the US's oil revenues should be used to support social programs, just as Hugo Chavez is doing with the oil revenues from Texaco in Venezuela today. So, Francis is a socialist.
  4. Francis L. Holland believes that the United States government should institute a national program of neighborhood health clinics where care is free, and frequently staffed by doctors and nurses who have received a free medical or nursing education paid for by the United States Government. So, Francis L. Holland is a socialist.
  5. Francis L. Holland believes the United States should study Cuba's national health care system and implement such parts of it as are necessary to reduce infant mortality in the United States to levels below Cuba's rate of infant mortality. Since the United States is so much wealthier than Cuba, it ought not be impossible to beat Cuba's infant mortality rate, if health care resources are allocated more equally and appropriately.
  6. Francis L. Holland further believes that the United States Government should expand and improve the system of Veterans Administration Hospitals until every person in the United States - not just veterans - can receive free medical care from these Government-run hospitals. These hospitals should be available in every city and area of the country, just like in Brazil. If this is socialism, Francis L. Holland is proud to call himself a socialist.
  7. Francis L. Holland believes that all medically necessary drugs should be available from the US Government for free, with the cost paid for by Government production of generic medications (like in Brazil) and bulk purchases of medications from pharmaceutical companies, as Wal-Mart does, and as the government of Brazil does. If believing that everyone who needs medication should receive it is a socialist concept, then Francis L. Holland is proud to be a socialist.
  8. I believe that garbage collection and dumping in a central government-designated location is an appropriate government function and I strongly oppose anyone who suggests that each of us should hire a garbage collector in the free market. If we had private garbage collection as our principle means of removing garbage, then we would have massive illegal dumping, courts clogged with cases related to the failure of these private operators to do what was expected of them, and massive transaction costs associated with weighing garbage and billing for garbage collection.
  9. I think garbage collection is analogous to health care. We all have health care problems from time to time, and the Government should be there to collect and dispose of those problems. When so many people need the same thing on such a regular basis, it only creates chaos to have hundreds of thousands of free-market profiteers doing what the central Government should do. Only small towns can survive without centralized garbage collection and disposal, and a nation of three hundred million people cannot possibly meet the health needs of its populace through individual contracts and private enterprise.
  10. Francis L. Holland is not a socialist as a result of his participation in any local, national or international socialist party. Francis L. Holland is a socialist by virtue of his own adopted political and economic beliefs, which are socialist rather than capitalist or anarchist in nature.
  11. Francis L. Holland believes that the role of the Government is to provide for the needs of the people. The Government's role ought never be to maintain a free market that provides for the opportunity for individuals to become rich by manipulating, exacerbating and capitalizing on the needs of the people and the markets.
  12. Francis L. Holland believes that the Government should represent the people, and the elected leaders should be representatives of the people. However, Francis L. Holland does not believe that United States' form of government is necessarily the best or only way to achieve this result. For example, the United States has 13% Black residents and only 1% Black representation in the US Senate, because every US state has a white majority and US Senate elections are statewide, majority-wins elections. In this sense, processes that are supposedly "democratic" can result in manifestly undemocratic results.
  13. Francis L. Holland does not believe that market forces should govern the distribution of a country's wealth unless those market forces result in a relatively even distribution of wealth. Where market forces result in grand differences between the wealth of rich and poor, with the poor lacking basic necessities while the rich have thousands and millions of times more resources than are necessary for their basic necessities, then these market forces are perverse and should be be disallowed.
  14. Capitalist market forces should not be allowed unless they result in a distribution of wealth that meets everyone's basic needs. As a matter of fact, purely capitalist market forces as a means of distribution of resources never meet the basic test of providing for everyone's basic needs, and that is why Francis L. Holland rejects purely capitalist free markets.
  15. Francis L. Holland supports those aspects of US Government policy that tend to distribute resources more evenly; such as free public schools; free public libraries, free streets, roads and highways that are paid for by the government from tax revenues instead of being privately owned; Government-owned national parks; nationalized military defense; national postal service, the national Centers for Disease Control, NASA, national baseline regulation of pollution and product qualiity control; and national efforts toward epedimiology.
  16. (By the way, why should we have national efforts of epedimiology and private capitalist treatment for disease in individuals? Why should the federal government concern itself with identifying diseases of national scope while rejecting responsibility for treating diseases of national scope? Why is it permissible to nationalize the identification of disease but not the treatment of disease?)
  17. The measure of representative Government is not the processes that are used to elect leaders but the results of those processes. If the processes do not result in representation of the people, then calling them "democratic" does not render them representative.
  18. Needless to say, neither the US's Democratic Party nor the Republican Party espouses the ideology explained above, and so Francis L. Holland is neither a Democrat or a Republican as those terms are used today in the United States. Francs L. Holland is a socialist who votes for the party and candidate that most approximate and least offend his views.
  19. In practice Francis L. Holland votes for Democratic candidates and not Republican ones because the Republicans favor unbridled capitalism and greed, with local, state and national police forces to assure that the unequal distribution of wealth is not overturned by popular revolt. Meanwhile, the Democrats believe in bridled capitalism with programs to ameliorate the results of unbridled capitalism, and with local, state and national police forces to assure that the unequal distribution of wealth is not overturned by popular revolt.
  20. Francis L. Holland believes that police forces, be they private, local, state or federal, ought never be used to impose or perpetuate upon a populace an economic or social relationship which does not meet the needs of the populace. And so, Francis L. Holland is neither a Democrat nor a Republican. He is a socialist.
  21. As a Black man, Francis L. Holland has considerable experience with being called derogatory names aimed both at him personally and at his demographic group as a whole. Like being called "Black", Francis L. Holland does not object to being called a "socialist"; he objects only to the negative and derogatory connotations that America's society and ideology have associated with the terms "Black" and "socialist".