First, I have to say that there is absolutely no easy answer to solving what I can admit is an unsustainable current state in healthcare. However, I have not witnessed a single politician or pundit stand-up and give an honest, if not politically prudent, assessment of what needs to be done in order to lower cost and provide benefits to the deserving.
This approach involves personal responsibility! Ah, say it ain't so...Americans actually taking responsibility and earning their right to health-care, either through education and occupation or by taking minimum responsibility to actually take care of one's self.
What I want to hear is someone say "not every American deserves healthcare." Imagine that kind of honesty, which would surely result in the immediate end of any political career, right? Unless they're right!
This is America, we have warning labels on cigarette's and people continue to smoke...guess what? Get lung cancer or heart-disease and pay for your own treatment. We all understand (at least should understand) that obesity will undoubtedly lead to increased health risks, including diabetes and cancer. Well, make no attempt to get your life under control and maintain a minimum level of health and you can pay for your own healthcare.
Why should insurance companies (via employers or not) or the government have to pay for people with blatant disregard for basic health precautions? Answer, they shouldn't! It's not fair to the rest of companies, government or the rest of us.
Now, I do think it's important to possibly allow coverage for children and elderly (assuming the elderly lived their lives within the minimum standards), so I'm not completely inhumane. I don't believe that everyone should be held to standards that are anything outside of basic, I'm talking minimums here, not that everyone has to be perfect. Far from it, just avoid some basic well known risks, and when a doctor documents a risk and you make no attempt to remedy the situation...you deserve to lose the right to coverage.
What would this look like in practice?
First, a general continuation of the employer provided healthcare system we have today. However, elimination of maximum pay-outs by insurance companies, with the option for companies to make a one-time payout to shift continuing coverage to the government. Once on government coverage all persons receiving coverage would be required to pay an additional % of income tax. The tax does not have to be excessive, it could be tiered to income, but it has to be something.
For the unemployed, government supported continuation of coverage (COBRA) unless an individual chooses to commit to government coverage, which would involve a commitment to pay for coverage (perhaps out of future earning via an income tax). This would again be subject to my personal responsibility clause, so it's not a guarantee unless someone actually attempts to take care of themselves (imagine that).
Now, as for children, I've already said I can favor 100% coverage for all children, up to 18 years of age. After 18, the cost of continuing coverage should be backed via 100% government loan financing for those pursuing continuing education on at least a part-time basis. I'm not saying the government should pay for it, but perhaps providing coverage for a set monthly or annual amount that is payable through education loans. In other words, the education loans would have to be approved at an amount for tuition, books, etc. plus a mandatory amount to allow for health coverage.
Elderly- As I said referenced earlier, just reaching a certain age while demonstrating continuing disregard for personal care does not provide one the right to healthcare. So, for those that demonstrate the continuing commitment to their health, they get coverage. those that don't get no coverage. So your choice going through life is, (A) maintain minimum standards of personal care and ensure oneself with continuing coverage or (B) demonstrate a disregard for basic personal care and clear disregard for ones own health and as earned, get no coverage!
And how about something to provide an additional benefit for personal responsibility, like a tax credit for preventative health. Say something like $500 credit for obtaining an annual physical and avoiding certain risks, which must be verified by the examination. Such as smoking, excessive alcohol abuse and obesity. As part of this I would require doctors to provide overall assessments and provide specific recommendations that if ignored would result in, not only the loss of the credit, but possible loss of future healthcare benefits.
Back to reality-
Harsh, yes. Wishful, yes. Any chance of seeing this happen? Absolutely not. We would never allow people to care for themselves in a responsible way in this country. Even though with my approach the person who hit bad luck, such as being involved in a vehicle accident or being stricken by an uncontrollable cancer or health condition would still be eligible for and receive coverage. And the individuals who display a blatant disregard for their health would give up the right to having any benefit in this country.
For a little quick reading on the subject of obesity and healthcare costs, check out this post by Greg Mankiw.
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