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Health care the GOP way

March 9, 2017


As sent to your Republican colleague conservative Rand Paul

The plans to debate a new health care bill follow the same standard federal government approach. This approach makes any federal budget impossible to predict and control. The defense contractors have their “huge entitled funds” flowing freely with calls for more money without any cutting to only fund the most cost effective programs.

Essentially the other “entitlement” laws promise to pay some of the cost of many living expenses to all (poor) comers. More exactly, federal cash is paid to everyone who enters an application to the vast bureaucracy of federal employees, who gather paperwork, and set up payments of billions of dollars. In several programs, funds are paid to an unpredictable number of people who meet each “poor folk” criteria. With only limited control to adjust “benefits”, cash pours out– Housing vouchers, free elementary education (mostly state funds), SNAP, Earned Income Tax Credit (really taxpayer income supplements to allow profit making businesses to pay people less than a living wage) and the current debate on entitled health care. I am conservative in my own spending. I will not borrow money without cutting my costs first. Living this way, I am financially secure except in the case of some health collapse.

To be clear, I do favor federal support for a minimal standard of living for the poorest people which supports necessities, given a higher minimum wage and the opportunity to work for pay that matches the costs to live.

On the other hand money earned by hard work should have a higher value than the government “funny money”, SNAP credit cards, housing vouchers, health care credits, EITC. These federal funds enter the market, compete for goods and services, and raise prices for everyone who uses real cash from their income. As I said, I do favor helping our poorest citizens to have some minimal standard of living in a country with our wealth. The problem is the great bureaucracy to administer the funds and add to vast federal rules and criteria. Another approach: create a total budget plan with a goal of getting entitlement and defense spending to ratchet down each year toward a balanced budget. These two items are the big bucks that we need to trim.

On the defense side, set some priorities and avoid lobby forces from steering money to the same good old boys versus funding only the most cost effective defense projects. Cuts need to be 10% or so each year ramping down to meet a balanced budget in some future year. Companies and their staffs that lose defense related jobs can find private sector jobs possibly during rebuilding our infrastructure.

On the entitlement side, each program needs to GET VALUE for the poor recipients. In SNAP, guidelines and limits on the type of food purchases will alert those using SNAP that earned money can buy some higher cost items that are not allowed for purchase with SNAP. Despite all of the studies on how much money people need for good food, I can find food in the grocery that assures that no one goes to bed hungry at 60 to 70% of current cash flow.

Housing has the same problem, landlords typically get a premium from renting under section 8 versus the market. Again the rental-rate math always disagrees with me, as determined within the great bureaucracy. So before we can “do the right thing” on health care, provide high quality care for everyone. The same idea applies: shut down the bureaucracy that plays the games of fee for service cost control. The federal bureaucrats cut the allowed payment for particular procedures then the providers meet financial goals by running “customers” through more procedures. Each side then spends more resources for staffs to play the accounting games, which add no value for the patient.

On to health care for all– get the Democrats on board who want the poorest to have some minimal life quality and work for better pay, thus they will need less in handouts, (read higher minimum wages tied to cost of living with some local guidelines).

I have studied health care costs and issues since the ACA was first debated. No federal act will be successful without over riding the health care lobby who are successfully keeping the steady inflation (high cash flow to medical providers) which occurs every year. As a parallel, we provide public education for everyone but not everyone gets to attend the pricy private schools that the wealthy attend. A per student payment funds public schools.

For health care for ALL, fairly funded “charity hospitals/clinics/doctors” could have an open door to patients, no co pay, no bills, no reimbursements through the current fee for service bureaucracy. Many people would be served with NO HEALTH CARE INSURANCE needed and no bureaucracy to shuffle volumes of paper.

Facility A has an annual budget to pay all employees, doctors, nurses, technicians, etc. and building overhead. Everyone despite age or income can just walk in or more correctly make an appointment. The federal funding would be a flat amount tied to the number of people served with small regional cost of living adjustments. These “charter” hospitals would pay staff at a level to attract qualified health care professionals. No bills to submit; no adjustments for treating the sickest people; no advertising to try to bring more people in and inflate patient numbers. Hopefully patient decisions are for the best health care with no incentive to inflate costs and by law, no malpractice claims for “good faith” work..

This would be a reasonable approach with high quality care but not “every thing money can buy”.

Lastly, data show that most medicare payments go to patients at the end of their life. Dying people need care without unlimited funds for fee for service payments. I am old. I hope to never have all of my assets or taxpayer funds drained to keep me living “by a thread”.


added words for my guy Steve Scalise:

In our federal government we are back in the debate over Health Care. The debate over Healthcare goes Way Beyond Health Care. It has hit the heart of underemployed, unemployed, and minimum wage employees. These groups are each in a strata that does not allow enough income to pay for the necessities of life.

Beginning with the bottom of the barrel, there are people who have virtually no income. They can be elderly or unemployed or employed in the cash economy. In any case they show no income for federal taxes and they do not qualify for earned income tax credit.

The next group of people may work full-time jobs, may even work two full-time jobs. The problem is their pay is 7 or $8 an hour and if they work 2,000 hours a year, they do not have enough income to match the cost of living where they live.

So the great bureaucracy has created institutions to make up the shortfall in the underpayment these people receive for their work. The money is fed back through Earned Income Tax Credit which pays back more money than was deposited in their tax account and can be as much as a $2 an hour boost. The food stamp SNAP, program and housing programs can easily add another 2 to $3 an hour to their pay. Now we may add another credit for medical insurance earned medical insurance credit EMIC. How much is that? —$3 or $4 per hour, total $7/hour paid for work, plus the $5 to $7/hour fed back from federal taxpayer/borrowed funds.

Of course the government has many people to manage these programs to collect taxes from some people and run it all through the bureaucracy to poor folks, instead of the low income people being allowed to earn $5 an hour more in the jobs they are holding.

As we move further up the income ladder, there are people with income based on 10-12, $14 an hour. These incomes frequently still do not match the cost for them to live a very modest life and certainly this income will not cover steadily rising medical costs.

So moving from the income side to the expense side, we look at Health Care and it is not affordable for any of these people. We could create an organization that feeds money back such as an Earned Income Tax Credit as an earned medical income credit, EMIC. This still does not solve the problem.

A better solution is to create hospitals that have little or no bureaucracy. They receive an annual budget that can be adjusted based on the number of people they serve. Anyone of any economic level can choose to be treated at these facilities and can choose to go to doctors who are part of this program. With some oversight, only the names and possible Social Security numbers would be turned into verify that the people were treated. There would be no billing for particular procedures. There would be no need for health insurance and Medicaid paper work for all people who choose to depend on the free hospital. Medicare patients could also choose to be served at these facilities.

The private hospitals and the health insurance would still be available for those who want to pay and can afford to pay the “going market rate”. Like the changes I envision for the SNAP program federal supplied money would have purchase restrictions, while money individually earned can allow the wealthy to buy whatever they fancy, expensive wine and even highest cost medical insurance.

The medical providers and their lobby are enraged at the thought of losing steady rising cash flow. The Democrats can join a bill if defense spending and entitlements can each be cut as the past budget cuts proved. Health care cannot be revised without a view to the total budget.

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