Blame this one on four wasted evenings watching the Democratic presidential debates. As Senators Bernie Sanders and Elizabeth Warren and the rest were describing their promise of “Medicare for All,” my wife and I were deep in the process of learning about and registering for “Medicare for Us,” which kicked in this month.
The big discrepancies between the two inspired my column (here) in today’s Richmond Times-Dispatch.
The debate over health care policy and payment systems is a perfectly valid one for national politics. Everyone sees the problems. Like it or not the country is about half-way, perhaps more than half-way, to a fully federalized health care system. Medicare, Medicaid and the military-related programs covered about 33 percent of Virginians in 2018, and federal regulations including but not limited to the Affordable Care Act dictate many policies for the rest of that sector. Both political parties have added to the structure.
It is also a debate where both political parties can put their operating ideologies to the test.
Republicans, including the current leader of that clan in the White House, can claim they favor personal responsibility and choice, more openness in pricing by hospitals and other providers, and using the power of government to bring the greed of the pharmaceutical industry under control (a focus of the current administration.)
Democrats, led by the most ambitious cadre of social engineers in their history, can claim they favor a total government takeover (like the now-dead postal monopoly), which will then set prices for hospitals and other providers, including the pharmaceutical industry. This will relieve the huge pressure on individual finances, and (seldom recognized) also provide a huge benefit to employers, many of whom will jump at the chance to pass off this burden.
Right now, our system contains elements of both approaches, but neither dominates, the moneyed interests manipulate both, and the resulting monstrosity satisfies no one (except those getting rich off it.) Both political camps point to the elements popular with their opponents and blame that for our continued frustrations, ignoring any failings in their own approach.
Neither approach is the solution if the goal is health, because in that arena like many others, the major problems – cancer, obesity, diabetes, heart disease – are largely due to our own bad habits, terrible diets and exercise-averse lifestyles. You can’t cure stupid, but we all share the cost of treating the long-term effects of stupid, either through the insurance pools or the tax system.
Are all the diseases or injuries people face lifestyle-driven? No, but the congestion and shortages within the health delivery system which drive up the costs are made far worse by the lifestyle diseases. That plus the outrageous end-of-life expenses, another feature of American health care not replicated everywhere around the world. Mention that and you hear “Death panels! Rationing!”
Medicare charges higher taxes in working years and then higher annual premiums in retirement if you have been financially successful. So far, I’ve seen no sign of any financial cost or penalty for the obvious risky behaviors (except some of the Medicare advantage plans do use medical underwriting exclusions and siphon off healthier retirees.)
Health itself is an issue no political party will focus on, because telling voters the truth about that will not earn their votes. On that one, Marianne Williamson is the Democrat making sense. She probably won’t make the cut for the next debate. A prevention and wellness approach to Medicare would be worth exploring. Don’t hold your breath.
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