Back to the Healthcare Drawing Board

There have been many efforts throughout time to make major changes in the laws of this country and the culture of its people in a short amount of time. I have found none that succeeded. Laws relating to civil rights, labor and workplace safety, environmental, and income taxes all took decades to come to fruition. They were all step by step processes.

Even the stock market crash of 1929 and the Great Depression were not enough to cause immediate passage of securities laws. It took ten years for all of the laws that are the foundation of today’s markets to be put in place. Ten years is extraordinarily fast for our government to make such sweeping changes.

Little victories laid the foundation (see the NEPA in 1969). An obvious and easy fix came next (see the Clean Air and Clean Water Acts of the early 1970s). The idea that cleaning the environment was important and that the government must lead the way became the norm rather than the other way around. RCRA, FIFRA, NRC, CERCLA, LUST and many others were passed, re-authorized and strengthened under both Republican and Democratic presidencies over the next 20 years until the framework of today’s environmental laws and culture were firmly in place. The last major environmental law was passed in the late 1980s.

Today the government is dealing with carbon emissions. The question is no longer whether this is the realm of the government. The questions surround whether carbon is really an environmental problem and if so, what are the ramifications.

So looking at history and reality, this government needs to look at healthcare as a long term incremental process.

Step one has got to be the establishment of the federal government as the source of healthcare regulation. Pass a first law that simply states that national healthcare and health insurance will be regulated across state boundaries by the US Department of Health and Human Services and that the States are now preempted from regulating healthcare, unless the insurance company or provider has absolutely no inter-state or federal involvement (no patients from out of state, no Medicare or Medicaid reimbursements, etc.).

Republicans favor this as it opens competition across the entire country, allows smaller creative carriers to get into the game, and eliminates the costly state-by-state compliance. Democrats should favor this because it gets the federal government in the game. This is critical if a government run plan is ever going to fly.

Step two will be to mirror the idea of the government option, by allowing associations to buy group priced insurance across the country for their members, whether they are companies, union workers or covered by the United Way. In the process, allow people to buy into the US government workers group plan if they want. This also spurs competition, which Republicans should like, allows commercial creativity and gets the federal government into the healthcare providing game.

Combine Medicare, Medicaid, Veterans benefits, US employee and military benefits under one umbrella and provide these as one. Take this out of the hands of the States and make it uniform across the country. Gain experience, eliminate red-tape, increase efficiencies, lower costs, compete and show that the federal government can do this extremely well.

If it makes sense, it is then a fairly easy next set of steps over time to add regulation and coverages provided by the government for catastrophic cases that go over a certain limit, cases that require experimental treatments, cases where the patient is permanently disabled, and high risk cases where malpractice is a big concern for practitioners. Take the step that begs for attention.

Finally, twenty years from now, universal government provided healthcare, IF it is still required to provide adequate coverage for Americans who want it.

There is an old saying, those who fail to heed the experiences of history are bound to repeat them. In this case, we should repeat what history shows us is the right way to make major sweeping changes.

Healthcare: Paying for It

While my brilliant 5-step plan laid out below is certainly the only possible way to go (he said with a wink), there will apparently be some form of significant government sponsored healthcare reform or coverage passed in the relatively near future. No matter what plan is chosen, it will be expensive.

Those who choose an unhealthy lifestyle should pay for this. Rather than taking away choices, we should tax those things that are voluntary and universally recognized as unhealthy for everyone. If my picture does not give it away, I am not a health nut. I am 50 pounds overwieght and adicted to high calorie foods, so I hate this idea. It is nonetheless the right way to go.

The tax should begin relatively small and should be set to automatically rise gradually, but increasingly, over 10 years to a point where the tax causes the bad stuff to be nearly prohibitively expensive. This should be made very clear so that all Americans have 10 years to develop a healthy diet or go broke. By gradually increasing the tax over time people will change their behavior at about the same rate. As a result, the tax should remain about the same as the stubborn pay for their unhealthy lifestyles to the bitter end, and fund the system.

If the government is going to pay for healthcare, then we should do our part. The problem is that we, and by "we" I mean "I," want our double cheeseburgers with Super-sized fries and a chocolate shake. This plan will not eliminate these options. Over ten years it will just make a “Value-Meal” cost $50 instead of $5. McDonald's will adjust.

So what are those things that everyone knows are bad for you?

Tobacco
Calories

That’s it. No one can argue that fewer of these two things will make us healthier and thus reduce health care costs.

Taxing “Calories” allows us to cover all the bad stuff you would otherwise target on its own: Alcohol, sugar, white flour, red meat. Over ten years the producers of these products will develop lower calorie versions that taste great.
- Beer will all be “light” and we will all be used to it.
- Hard liquor will become lower proof (80 to 60 to 40) with better ingredients to retain the taste. Fewer drunks would also reduce healthcare costs.
- Bison will gradually replace some cattle and beef will be leaner.
- We will eat more chicken and fish and maybe Ostrich.
- We already have many versions of substitute 0 calorie sweeteners.
- All soda will become “diet” soda and there will be no such thing as “regular” soda. Zero calorie soda will have no tax.
- Restaurants will serve smaller and healthier portions. Fettuccini Alfredo will either leave menus or be made with lighter milk because the restaurant will be hard pressed to afford the tax on heavy cream.
The key is that it will take ten years. We will adjust gradually. We are innovators. We, the poor, middle class and eventually even the wealthy, will all learn to eat better, providers will sell smaller portions, and food producers will learn to make healthier food. We will adapt and innovate and be able to afford healthcare.

Tobacco: This is easy. Tax it at every stage of production. Seeds to cigarettes. Start with the significant taxes we impose now and gradually raise them over 10 years until a pack of cigarettes is $50 in today’s money. Each year 10% of smokers will quit or not start due to cost alone. In ten years, there will be no remaining tobacco products to purchase. Rehab will be the cheaper alternative.

Calories: This at least seems more difficult, but it really is’nt.
The tax would occur at the point where the US distributor sells to the US retailer, whether the retailer is a restaurant or a grocery store or a farmer’s market. The US distributor may grow the products or purchase the products domestically or overseas. Where they get them is not relevant.

Establishing the tax is also not difficult.
We already rate meat based on how lean it is. The distributor can reduce his tax by trimming it closely. There is probably a simple way to do this that scientists understand.
Produce is pretty easy. Broccoli has a pretty standard number of calories per ounce.
Anything in a box has the calorie count right on the side panel.
Sugary cereals, candy, ice cream, etc will go the Splenda route or become very expensive. Pure perfect ice cream will still exist for really special occasions.

In the beginning the tax will be relatively low. Twice each year it will go up a few percentage points for ten years. It should accelerate as the ten years nears its end. At the end of ten years it will level off at a rate that will seriously dissuade Americans from eating too many calories.

The only exception would be baby food for those under three years old. Babies need calories. Adults do not like baby food, so I doubt this will create a calorie abuse problem.

Combine this with cultural changes we are already working on. Eat less. Exercise. But every medical practitioner will tell you that you lose weight by eating fewer calories, not by exercise alone, though it helps.