Balancing National Health Care with Caring for National Health

As we move beyond the various emotions that are inherent in the days and weeks surrounding a democratic election, we are left to sift through a variety of campaign promises and speculate upon which of these will become policy and which will be stored in the political lexicon for future campaigns. Though the economy took center stage as the most important issue of this election season, and stands to garner the most immediate attention of the new administration, health care reform continues to be a major point of concern that must be addressed by president-elect Obama and the democratic congress. Throughout his successful race to the White House, Barack Obama outlined a nationalized health care plan which relies largely on the expansion of our current Medicaid system. This is alarming considering we fund the current medical entitlement programs with money set aside for future social security liabilities. (emphasis added)

In order to get an idea of what Medicaid expansion might look like under the Obama administration, let us examine the expansion of Illinois' system while the President-elect was serving as a member of the state senate.

The Obama campaign continually pledged to expand eligibility for Medicaid and SCHIP (State Children's Health Insurance Program) to ensure that the poor individuals and children have access to health insurance. In 1999 Illinois implemented their KidCare program through SCHIP as a way of providing health insurance to uninsured children, much like Obama plans to do on a national level. The financial implications of this program are staggering. From 1997 to 1999 Illinois Medicaid spending grew at an annual rate of 0.6% compared to a national average of 5.4% - a very sustainable rate which posed no threat to Illinois' financial well-being. Conversely, from the time KidCare was implemented in 1999 through 2001, Illinois Medicaid spending grew at an annual rate of 20.1% compared to a national average of 9%. It's hard to argue against providing children with medical care, but the larger financial implications of this ambitious effort can be severe. Since 2000 Illinois has run a structural budget deficit averaging around 10% annually. According to the Center for Tax and Budget Accountability, "In an effort to reduce deferred Medicaid liabilities, in June 2004, the state borrowed $850 million to avoid carrying over those Medicaid costs into the next fiscal year…Illinois still deferred over $1 billion in Medicaid liabilities into fiscal year 2005." Given our current financial state, the concept of borrowing money to fund current debt liabilities is extremely dangerous and can have consequences reaching far beyond the realm of health care.1

The Congressional Budget Office projects that Medicaid and SCHIP spending by the federal government in fiscal year 2008 will be $205 billion with programs covering 57.4 million beneficiaries. Simply based on the CBO's projections, which do not account for an expansion of Medicaid or SCHIP programs, these numbers will increase to $270 billion spent to cover 58.7 million beneficiaries by 2011.2 This $65 billion increase is not a small amount, but what will the number look like if Obama is able to implement the Illinois KidCare program on a national level? If we apply the 20.1% increase in spending that we saw annually from 1999-2001 in Illinois while KidCare was being implemented to the CBO's 2011 projections, federal spending on Medicaid and SCHIP programs in FY2011 will soar to a staggering $355 billion.

The increasing cost of health insurance, which has doubled over the past eight years, coupled with the growing number of uninsured Americans has created a situation that must be addressed by the incoming administration. However, the expansion of medical entitlement programs is not the solution to this dilemma. The national deficit ran $162.8 billion in FY2007, which will pale in comparison to our post-credit crisis deficit.3 The new administration must do something to refurbish the health care system, stabilize premium costs and expand coverage for those unable to afford it. Nonetheless, we can not allow ourselves to fund this effort by indebting future generations. President-elect Obama and the 111th Congress are faced with the responsibility of guiding the nation out of one of the most devastating financial crises in history. Given the circumstances, it is imperative that the federal government act with prudence and moderation in approaching their health care agenda. They can not act in haste and further complicate, or ultimately compromise, the mission of stabilizing the American financial system. The health of our nation depends on it.

By Bart Seifert

Hat tip: Bob Cusack

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Response by Sue Curtin:

Oh I definitely agree: Obama and his administration, (small "d" democratic) will have to deal with the (large "R"?) outgoing administration that has led the country into this financial crisis. What a wonderful way to begin an administration! No doubt doomed to failure? I wonder who is cheering behind the scenes. And, for heavens sake, what in the world would McCain/Palin have done, had they won, that would be intelligent, targeted, and effective?

Yes, the costs of a national health care plan, however you cut it, however you exclude certain people or include them, will be expensive. But we have not yet seen the parallel costs of public health care and disease estimates for those without health care, who crowd our hospital emergency rooms (their only health care option) or who carry unprevented disease within our society. National health care in my opinion is a PUBLIC HEALTH concern. We're all part of that public, regardless of where we live. Do we live in a gated community that can keep out the hordes?

Just consider the rise of tuberculosis, a managed disease previously, which in our country is now spreading because of lack of mandatory health care. Yes, I'm sure some would argue that those TB carriers would not seek health care. But let's seriously think about the millions of people who inhabit our society (of whatever race, ethnicity, gender, etc.) who have no preventative health care. Isn't this a public health concern? Should those of us outside heavily populated areas of this country even care? If not, why not?

The health of our people, in my opinion, is an investment in what John McCain cited is the fundamental strength of our economy: the American worker. Have we yet seen the statistics that could help us understand how good health impacts worker productivity? We already know that no statistics describe CEO productivity particularly; the CEOs, some of whom are brilliant and some of whom are excessive failures, collect amazing salaries whether they are sick or well, successful or not. Productivity for CEOs has a different dimension than for workers. We should compare all these statistics with other industrialized countries, such as Germany and Japan. And make corrections for the recession we all are in.

These are important and serious issues for the overall health, in many ways, of our country. We've faced similar times before: when children had no protection and worked in appalling conditions in our factories and mills; when women and immigrants labored without sufficient protections from accident or layoff. Yes, I'm a union woman, former president of a teachers union -- and proud of it, considering what conditions and salaries we won to help the true educational experts in our school systems, the benefits of which have been reaped by our collective students. And the parents cum taxpayers agreed, because they supported the agreements.

Can we afford what needs to be done (if, in fact, we can agree on what needs to be done?)?

I am optimistic we can. We've reached a watershed in our history -- not about race, but about the middle class. Without a strong middle class, we do not have "the shining beacon on the hill," we do not have the "American Dream," we do not have opportunities for immigrants as the history of our immigrant country granted to us. Without these goals and themes, without the wherewithal to achieve them, without the collective will to survive and improve and go forward for all our people, we will find ourselves remembered in history, along with several other well-known empires, that sank away sadly because of their own hubris and neglected the very people who gave their promise its strength.

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Response by Marty Dillian:

Well, we all definitely view the world through different lenses.

I agree with the assessment of the current administration. Calling them ineffectual would be kind. History may put them in last place, in the last seat, in the last row, as the 'anchor man' of United States history, even behind Jimmy Carter. However, putting the blame for worldwide financial monetary collapse, and I mean worldwide, completely on one man, or one President's administration, is illogical and ignores volumes of facts. You would have a far better argument blaming Congress, and from there the list is long and distinguished across many nations if you want to spread the blame around even more. Same was true of the Clinton legacy. Same will be true of Obama and Biden. Defending Obama's future administration of healthcare by attacking the competency of an alternative McCain/Palin healthcare plan is a hoot. First of all it is not relevant given the election. Secondly, we have to deal with what is, not what might have been. And lastly, why be critical of an imaginary McCain plan that will never be? And in any case, no facts are known for sure except that Obama wants to pursue greater redistribution of wealth and income to advance socialized medicine. Few Americans have any idea what this will entail. Few understand how disadvantaged they will become by the myriad implications of socialized medicine.

Maslow's Hierarchy of Needs

It is my opinion, which is worth what you paid for it, that healthcare is earned; healthcare is not a universal Right. I could suggest to you that everything on the Maslow hierarchy of needs is earned - at every level. Nothing at any level is a human Right - except liberty, life itself, and the unfettered pursuit of happiness. Democrats and liberal Republicans have successfully sold the notion to the American people that Maslow's first four levels of needs: psychological, safety and security, love and belonging, and esteem should be a Right - a gift of government as a direct consequence of confiscating another man's wealth and income - rather than individually earned.

We have the freedom to pursue the best you can be in your life. However, you should harbor no expectations that I will support you, your family, your healthcare, your transportation, your food, your education, your housing, your entertainment, or condone and subsidize your psychological weaknesses and pathological self-neglect, etc. at the expense of my own family. It's not going to happen.

Yes, the United States of America is supposed to be a gated community. On a smaller scale, so is my home. Nobody has a right to anything in my home, nor a 'cut' of my wages. Nor does any man have a right to take from my wages, at my workplace, like a thug demanding a payoff (withholding taxes) under the guise of promising socialist protection of everyone. From top down, the country will soon look like one nationwide labor union, with everyone paying dues (Withholding and FICA) in order to have the 'privilege' to work.

Egalitarian dreams of reducing everyone to the same common denominator, some lower common denominator, are too expensive for this country, and this family in particular, to afford. If you want to relinquish half of your own family's wealth and half of your income to benefit others, people who in most cases have made no effort in their own behalf, be my guest. I applaud you. I applaud all forms of voluntary charity. I'll put you in for some kind of international award with the Mother Theresa Foundation. If you want to live in a commune or collectivist society, such as the People's Republic of Massachusetts, I won't oppose you or try to prevent you from making your own decisions. I'll encourage you. And the converse is true. If I don't want to live like that, don't try to impose your life-choices on me. Just remember, if you try to force me to do the same thing as you, to impose what you wish to be, by force of government, you are literally denying me my Right to liberty; and that my friends is tyranny. It's never worked for the benefit of any culture in recorded human history and statistically it is unlikely that it ever will. And it won't work in my case.

The issue in my view is not who to include in a national healthcare plan. The answer is simple - nobody. Access to healthcare is an individual issue. You decide what you need, where you are going to shop, what you are going to buy from available choices, and how much of it you can afford. Restating for emphasis, make the purchases of what you want where you want in the quantity you want using what you can afford.

Nor should everybody have to shop at Wal-Mart.

Everyone should not have to shop in Wall-Mart-style for their needs, and grow accustomed to expect that the government will send their bill to you and me. Maybe that is what Sue in her response is suggesting. Someday, maybe the only business allowed by the government will be some type of Soviet-style Wal-Mart and everybody has to shop there. The government will decide what to stock on the shelves, from clothing to healthcare. People will come in and take what they want off the shelves. Many, according to Obama's Marxist views, should be able to leave with a government sanction not to pay. However, you and I have to pay full price, and then we can expect to pay extra for everyone else, including a subsidy for their food, clothing, medical care, entertainment, etc. Wow. That's what you seem to be advocating for healthcare. Why not everything else? We just tried socialized housing, and that was an economic disaster that may take this country, if not the world, to its knees. And now you want to attempt the same death-defying circus trick with healthcare? And you anticipate a different outcome?

The issue for emphasis is socialized medicine itself, which you appear to want to impose on me, which is a system in which the government chooses, instead of permitting me to choose, which has repeatedly been demonstrated to reduce the standard of healthcare for everyone (study Canadian experiences), and which will be imposed by force, and at a staggering cost to the few who still pay taxes, and at a staggering cost to those who don't pay taxes in the form of costs passed through to the consumer. It is not an understatement that the government will decide who lives and who dies, through controlling access to medical care, setting arbitrary criteria such as age, gender, race, prior medical history, retirement status, political affiliation, criminal history, education, influence, etc.

What is democratic about forcing an economic system on people who don't want it, or anything else for that matter? Because it’s for the greater good? Wow. Break out the Kool-Aid if you believe that ever-more socialized medicine is for the greater good.

In conclusion, an unknown author once said: “Give a man a fish and you have fed him for today. Teach a man to fish and you have fed him for a lifetime." Suffice it to say that no man is going to forcefully take my fish, and simply give (redistribute) it to another man, because you, or anyone else, thinks he has a greater Right (or need) to it than does my family. You are an educator. Teach the man to fish and he will eat. After 30 years in the teaching trade, are you finally admitting to the world that you and the collective teacher's unions have been unable to teach men and women to fish? Nor could you teach him a work ethic in order that he could sell his extra fish and use the proceeds to pay for his own healthcare. It appears incontrovertible, that after all these years, a federal education department and trillions of dollars, that you cannot teach some men to fish - so instead our national solution should be to subsidize their sloth and institutionalize wealth expropriation on a national scale?

Liberty is best exemplified by having the opportunity to freely exchange (unfettered by government interference) our earned (or produced) goods and services for goods and services that we and our family needs or wants. Taking from my family what you need or want, by force of government, either for yourself or to redistribute to someone else, is (fill in the blank).

Posted November 15, 2008 04:13 AM
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