Scripted Thinking on Health Insurance
Republicans are approaching health insurance as if they were the better managers of socialism. Why not take this opportunity to express the core principles of conservatism for better solutions?
As the Senate grapples with the Gordian Knot of universal and affordable health insurance, senators have fallen into the script that publicly funded health insurance is tantamount to a constitutional right. It isn't, and through the collective fog of "government money," they're obscuring the reality that, in effect, one neighbor is knocking on the door of another, demanding that he pay up for a "human right." Blindness to this reality is leading the Senate to irreconcilable conflicts within the majority party because personal responsibility and true conservative values are being ignored here. What the Senate is left doing are back-room shell games to devise clever ways of disguising the redistribution of health insurance costs. It won't work.
Let's first clarify a few points. Health care is the treatment of a medical condition. Health insurance is how that treatment is paid for. You cannot call it "insurance" for pre-existing conditions. Insurance deals with the probabilities determined from actuarial tables, not an existing event. Paying for an existing condition is cost-sharing, pure and simple. Calling it insurance is deceitful. Furthermore, buying insurance is (and should be) a voluntary act; compelling people to pay for the needs of others is not.
The other point concerns the term "affordable." Affordable to whom and for what amounts? If a healthy, low-risk 26-year-old male is forced to buy health insurance coverage for unlikely probabilities, does that fall within the definition of "affordable"? If a family of four has to pay $1,000 per month for health insurance while another, who makes perhaps $5,000 less per year and falls within a subsidy income limit, would pay much less, is that a definition of "affordability"? Are we conservatives in effect embracing a social scheme that would make people pay for things they don't need or penalize upward mobility? Can we at least get the definitions clear from the outset?
On the topic of affordability, where is the responsibility of the general public? Current statistics show that two thirds of Americans are overweight, which spawns a whole spectrum of disabilities and ailments. And we're gulping down medications – particularly opioids – as though they were Tic-Tacs. Too few of us exercise regularly, but we do find five hours a day (on average) to watch television or play videogames. And our diets are horrendous. Look: no politician would ever dare say this, but if the general public is going to live as if there's no tomorrow, why shouldn't it be charged as if there's no tomorrow?
Clearly, rising demand for medical treatment for preventable causes must be a component of our national dialogue on this issue. Otherwise, any solutions ignore an economic truth: that rising demand results in rising costs. This rising demand siphons money and resources away from those whose afflictions are not the result of lifestyle choices – and those are precisely the people most deserving of any public cost-sharing scheme.
Is there really a heartlessness to demanding that if someone receives a public subsidy for his health insurance, he should at least show progress on becoming a healthier person? Perhaps require a quarterly weigh-in for continued benefits or show us an attendance log at the local gym? After all, aren't the declining rolls of food stamp recipients – where work requirements are placed on able-bodied individuals – a shining beacon of how the conservative value of personal responsibility can help resolve this health insurance problem?
So why aren't we using our conservative values in thoughtful and creative ways to address our health insurance issues? Why not make it a prerequisite that in order to receive any government benefits, you must have at least catastrophic health insurance coverage and show regular contributions to an established Health Savings Account (HSA)? That would include government-backed school loans or grants. If you receive a tax return or an Earned Income Tax Credit, a portion of that should be a separate check made payable only to the recipient's HSA account. If you are a full-time student and working part-time, you will not have to pay taxes on your tips if you fund a certain percentage of your imputed income to an HSA account as well as maintain a catastrophic health insurance policy. One might even go so far as to make it a requirement to obtain a passport.
These are just a few ideas, and, workable or not, they illustrate how an individual mandate is unnecessary if obtaining health insurance and funding an HSA account can be constructed to align with a person's self-interest.
Congress is also looking to pass some measure of tax relief and to somehow couple that with funding health insurance benefits. With a $20-trillion debt, that's simply not plausible even with an increase in economic growth. So here's some more creative thinking:
U.S. corporations have an estimated $2-plus trillion in overseas income they keep offshore to avoid U.S. corporate taxes. Prior efforts to bring that money home were ineffective. But let's suppose that we created a National Health Care Trust. Initially, a U.S. corporation can deposit its overseas income into this trust and be solely responsible for the prudent investment of the funds it deposits. A percentage of those investment earnings – say, half – is payable directly to health insurance companies as a direct subsidy for insurance coverage for those who need it. Each following year, the corporation makes a percentage contribution to stay active in the fund, and in return, the balance of its overseas earnings can be repatriated tax-free. So here you would have meaningful tax reform, a mechanism for profit for otherwise taxable earnings, a growing source of funding for domestic interests, and a bridge of health insurance coverage for those who lose their benefits from job loss or other circumstances.
Again, just creative thinking and an exploration of possibilities rooted in conservative principles. Yes, there are plenty of details to cover, and I can already imagine the cacophony of "it can't done" comments. But this isn't a comprehensive legislative proposal; it's a policy argument. The health insurance script we have today is compelling us to speak lines that belie our core beliefs – that we believe in a hand up and not a hand-out, that elevating our national character is best achieved by holding individuals responsible and accountable for the benefits they receive, and that government can best serve the public by guiding its producers to explore free-market solutions to elevate the general welfare.
That's what's we need to untie this knot.