… who is wor­thy?

Modern Healthcare - - Opinions Letters -

The po­lit­i­cal right has tried to de­rail ef­forts to re­duce the num­ber of unin­sured with mostly silly ar­gu­ments of ex­treme con­se­quences like putting grandma at the mercy of

death pan­els. To re­claim some con­ser­va­tive dig­nity, here are some dis­pas­sion­ate ar­gu­ments that have been largely ig­nored for why we’re leery of Demo­crat-de­signed re­form. First some facts: Poor peo­ple are in­sured through Med­i­caid. Vet­er­ans are cov­ered. Se­niors have good cov­er­age through Medi­care.

Only 18% of Amer­i­cans are without health in­sur­ance.

Of those, 20% are not cit­i­zens, 22% earn three times the poverty line, and 23% are el­i­gi­ble for Med­i­caid or the State Chil­dren’s Health In­sur­ance Pro­gram but don’t sign up for it.

The left wants to man­date cov­er­ing most or all of the unin­sured one way or an­other. The right re­jects that in­ter­ven­tion be­cause we re­sent pay­ing for health­care for those who could pay for it them­selves but don’t.

Here’s a model that might get the left and right com­mu­ni­cat­ing again: the ed­u­ca­tion model.

We de­cided years ago that uni­ver­sal pub­lic ed­u­ca­tion is good and a ba­sic right. So, we fi­nance 100% of grades K-12. That’s enough for some of us. For the rest, there’s Har­vard Uni­ver­sity, Stan­ford Uni­ver­sity and the like. But most of us can’t af­ford th­ese “Cadil­lac” in­sti­tu­tions.

So Cal­i­for­nia and other states of­fer sub­si­dized uni­ver­si­ties like UCLA, and a net­work of com­mu­nity colleges. The cost to tax­pay­ers in Cal­i­for­nia: 15% of the Uni­ver­sity of Cal­i­for­nia bud­get, 49% of the state col­lege bud­get and about 30% of the com­mu­nity col­lege bud­get. The rest is paid by tu­ition, fees, schol­ar­ships and re­search grants. So, ev­ery­body gets a ba­sic ed­u­ca­tion and we help those want­ing more. Could this work for health­care?

Where con­ser­va­tives rise up in op­po­si­tion is to the no­tion of send­ing peo­ple to Stan­ford at tax­pay­ers’ ex­pense, es­pe­cially peo­ple who could af­ford to pay the tu­ition them­selves. We need first to de­cide if health­care is a ba­sic right. We have al­ready cov­ered the safety net with Medi­care, Med­i­caid and SCHIP (like grades K-12). What we’re strug­gling with is how much the tax­payer should chip in for those who need health in­sur­ance but don’t buy it.

The cur­rent de­bate in Congress is over the wrong sub­ject. Our leg­is­la­tors should be looking at the unin­sured care­fully to de­cide who is wor­thy of sub­sidy be­fore de­sign­ing the pro­gram to sub­si­dize them.

Jef­frey J. Den­ning Med­i­cal prac­tice an­a­lyst Prac­tice Per­for­mance Group

La Jolla, Calif.

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