Compulsory education has existed for over 100 years in our country. The overwhelming majority attend public elementary and high schools. According to the Council for American Private Education (CAPE), ~10% of all US students attend private schools. According to the US Department of Education, around 3% are home schooled. If I do my math correctly, it means ~87% of our children our taught by the public school system. A system that is funded by our tax dollars.
Why do we spend the money and time to educate our children? We’ve determined that our society functions better and that people are more productive if they are provided a minimum level of education. And in today’s international arena, having an educated workforce is a requirement if a country and its business want to be and stay competitive.
Education carries such a high level of importance that every state has public funded institutions of higher learning. These exist as community colleges, teaching colleges, and world-renowned research universities. In my opinion, making higher education accessible and affordable is the cornerstone to a state’s growth. As a resident of California, I would content that affordable access to the University of California system was one of the primary elements leading to the growth of California in the second of the 20th century. It does not surprise me that California’s growth has stagnated in recent times as access to this system has been restricted through reduced public funding and higher tuition costs, but that’s a topic for another time.
If education is important enough to warrant public funding, shouldn’t the health and welfare of our populace be handled the same way?
Parallels to education
Just as we’ve determined that an educated workforce is more productive, so is a healthy one. People perform at higher levels when they are in their best physical and mental shape. If we accept as fact that healthy people are more productive, then it would be in our collective best interest if everyone had access to a minimum level of care.
Also, just like the education, the earlier we can teach people how to lead and sustain healthy lifestyles, the easier it will be for one to maintain their healthy habits later in life. Too many children are not getting proper health and nutrition advice. It is leading to increased levels of childhood obesity, type 2 diabetes, as well as behavioral issues, which only get worse as they age. It drains our productivity and burdens our health care system. In other words, providing kids access to proper health care when young could help to prevent health issues later in life.
And similar to private schools in the education, a public health care system could provide the opportunity for people to pay “out-of-pocket” to see private medical providers and facilities. Insurance companies could offer supplemental coverage plans that would permit people to go to private providers or to cover medical procedures and treatments that were not covered by the public system.
Enabling a more competitive business environment
Today’s health care environment gives large businesses a significant advantage over smaller businesses and self-employed individuals. Large business have the resources and buying power to provide their employees with comprehensive health benefits that give them a competitive advantage when recruiting new hires.
By providing a minimum level of health care benefits through a public plan, smaller businesses would have access to a much larger pool of applicants who may prefer working in a smaller environment but cannot afford to give up their benefits. I know this from experience. I run a small business, and the costs of providing medical benefits is prohibitive. There have been many potential applicants that have had to pass on the opportunity due to lack of benefits despite their interest and desire to work at the company.
Furthermore, individuals who would like to work on their own or start their own business would benefit greatly from a single payer plan. People would not have to make the trade-off of chasing their dream or having health insurance. It is a well-known fact that entrepreneurship spurs growth and innovation. Having minimum levels of health care could be a catalyst that spurs growth and innovation.
Health insurance in the current system is a tax
Despite what the Supreme Court and others would say, health insurance these days is a tax. The ACA, which makes having insurance a mandatory requirement, does not help individuals. In the last four years, my health insurance costs have doubled. Less services are being covered and my out of pocket costs have gone up. Higher costs, less benefits – not a good combination.
If anything, the ACA has benefited the insurance companies. It is a handout that guarantees their profitability. Carrying insurance has become a tax that all pay with the brunt of the burden shouldered by small business owners, their employees, and middle income families and individuals who do not qualify for government tax credits or have employee provided plans.
The time has come for single payer
While the old system had its issues, at least it offered individuals choice. You could opt for insurance, choose to pay out of pocket for health care, or opt for some combination of the two. Insurance companies had an incentive to develop compelling policies, plans and terms that made it worthwhile to have insurance. For some, like me, insurance could serve its primary purpose – as a safety net. Day-to-day health care could be covered out of pocket with insurance covering health emergencies and extended illnesses.
As it stands, the current system is broken. It’s the worse of both worlds. It restricts consumer choice regarding decisions to have insurance and forces individuals into expensive plans that do not meet their needs. As mentioned above, these plans are more expensive and offer fewer benefits than pre-ACA plans, unless you qualify for government tax credits.
If we’ve determined that we want everyone to have access to a minimum level of health care, then it’s best that we just acknowledge it and move to the single payer system that the rest of the developed world has embraced and adopted. The outstanding question is how to pay for it.
Covering the costs of single payer
Since the current system is effectively a tax, let’s formalize it. One option would be raising the FICA tax for Medicare from the current 2.9% to 5.8%. As with social security, the rate would be split between employer and employee with self-employed individuals paying the full 5,8%.
If increasing the FICA tax means I don’t have to pay for insurance and have access to a base level of care, I am way better off than the current system. My effective tax rate would drop substantially while the level care I have access to would stay the same or improve. This benefit should apply to all individuals, regardless of income level. Business, especially small ones, would also benefit as their health care costs would drop substantially, year over year benefit costs would be more predictable, and their potential hiring pool would increase substantially.
As mentioned above, the insurance companies could provide supplemental insurance. These policies could cover those procedures and treatments that are not covered through the public health system.
Implementing single payer
The transition to single payer could happen immediately by leveraging existing programs and expanding them. These programs could then be modified and adjusted over time.
We could take the existing Medicare program and expand it to cover all individuals and not just those 65 and older. The system would get the additional funds from the increases in FICA tax. Most medical practitioners and facilities already accept Medicare. It wouldn’t require having to setup a bunch of new facilities prior to launch, although these options could be increased and improved over time.
Over time, I would suggest that program implementation and choices were pushed to local governments, preferably at the state level. Individual states could use Medicare related funding to open up public clinics that would provide a minimum level of services. Co-pays, percent of coverage, or supplemental policies could cover specialists and emergency services. People could also be rewarded or receive credits for following recommended diet, exercise or other health related guidelines.
Health care and education go hand-in-hand
Public education is not perfect, but it works. Lisa and I came out of the public education system. I like to think that we’re productive members of society. My kids have gone through the system, and they are doing fine. If we are willing to create and fund an educational system, why aren’t we willing to do it with our health care system? Wouldn’t our society be more productive if everyone was provided at least a basic level of health care? I believe it would be. It’s time we stepped up to the plate and provided it. We’re paying for it either way, so we might as well do it in a way where everyone benefits.
Unfortunately, as with all discussions these days, the conversation is focused on winners and losers. It’s capitalism versus socialism. Republicans versus Democrats. Left versus Right. Why can’t we have a rational discussion and engage in discourse over common sense solutions? And bear in mind that this course of action is coming from someone who favors smaller government and prefers less government involvement in my day-to-day affairs. However, there comes a time when government can and does serve a role. Health care has become one of those times, and roles. Nearly every developed country has realized this fact. Why haven’t we?