Wednesday, May 13, 2009
All this is an introduction to an e-letter I received this afternoon, in which the writer urges me to support President Obama's health care plan. Here is part of the e-letter:
Monday morning, an unlikely gathering of health care industry and union leaders emerged from the White House, announcing a historic agreement to lower medical costs and save the average family up to $2,500. This kind of broad coalition would have been unthinkable in the past, when the old politics of division and short-term self interest held sway. But this is a new day.And that afternoon, President Obama announced the three bedrock principles that any comprehensive health care reform must achieve: (1) reduce costs, (2) guarantee choice, and (3) ensure all Americans have quality, affordable health care. And he set a hard goal for getting it done by the end of this year.
For those determined to oppose reform, the President's announcement means lobbyists are already scrambling across D.C. For the rest of us, it means there's no time to lose. As we speak, Congress is negotiating the details for health care reform, so the first step is showing where the American people stand.
I am baffled. The writer wants me to support President Obama's plan for health care reform. I don't know what the plan is. All I am told by the e-letter is that it contains "three bedrock principles." There are no details. I think the principles are good, but if I were trying to construct a plan I wouldn't classify them all as "bedrock" principles. The only I would call a "bedrock" principle is to "ensure that all Americans have quality, affordable health care." The other two goals are nice, but if I had to choose between ensuring good health care for all Americans and reducing costs or providing choice, I would go for providing good health care for all.
I know nothing about Mr. Obama's health care plan, or rather I know too little about it to become a public supporter. I am faced with the same choice I had in 1994 with the Clinton health care plan: whether or not to support a plan whose details I knew little about.
My idea is that we can provide good health care for all Americans by simply making them all eligible for Medicare. Everyone would have to pay a Medicare tax, of course. That tax could be tailored to enable very poor people to afford coverage by reducing their tax in accordance with their incomes. In Medicare, everyone has a choice of doctor. One can join an HMO as I have done or can participate in fee for service medicine as I did at one time under health insurance subsidized by my employer. Everyone should be able to have the same or better level of health care as I have had. For me, it's turned out well so far. I'm 86 years old and still enjoy good health and good appetite.
Mr. Obama has lately been talking about the importance of reducing and containing costs. Perhaps he has in mind the Canadian or English models, in which medical procedures that are deemed elective (i.e., not necessary to save life or quality of life) are delayed or rationed. He and others have talked about eliminating unnecessary medical tests and other procedures as a means of reducing costs. I have no problem with this in principle, but, as usual, the devil is in the details. Who is to determine what's necessary and unnecessary and what are the criteria?