I will be discussing the portion of the social security act
that became Medicare. If you go back and reread the preamble there was nothing
specific that talked about medical coverage. It was the general statement: “…make
adequate provisions for the aged person….” that Medicare can be derived or at least
in my thinking.
First though let’s tackle another issue and that is
healthcare in this country overall. I do not think we can tackle improving
Medicare until we address some other issues. We seem to have healthcare upside
down.
The primary people in healthcare should be the patient and
the doctor. Unfortunately Wall Street, big pharma, insurance companies, for
profit hospitals, and a few other identities seem to get the most attention
from Washington D. C. Outsize profits
seem to be the order of the day in healthcare instead of patients’ health. Now
I do have to be careful in addressing this problem. One question is how do you
define outsized profits? Just starting there touches on the basis for many of
the problems facing healthcare in our country. The primary question is do we go
to a more socialized medicine concept or do we let healthcare still be open to
the general market place? If we go to
socialized medicine it resolves dealing with outsized profits, but opens up
other issues. If not, how do we determine what is a reasonable set of
expectations for the health care industry in regards to profits and overall
business size. And of course how do we
get it back to making the patient and the doctor the primary focus.
And resolving the healthcare issue is one of the great
examples as to why democracy should work or more importantly why it needs to
work. Healthcare is not a right, but it is an obligation for the individual and
for society. People can expect that their health is of more importance than the
benefit of the system that provides healthcare. How does this work?
One problem is the failure of what is commonly referred to
as Obamacare. There is definitely some benefit in trying to overhaul a system
that was getting out of hand. Expenses to the patient and overall insurance
costs expenses are becoming untenable to the middle class’ budget. And being
able to afford insurance to prevent a catastrophic illness from destroying a
family’s budget/life/future is a wonderful benefit. Obamacare did not resolve
this problem. Sure many more people have insurance, but the cost of health
insurance is still going up and the cost of medical care is still going up and
is going up faster than wage growth. And then you read many insurance
companies, pharmaceutical companies, for profit hospitals are making money and
some of them making very large profits and add on that they have to meet Wall
Street expectations as to earnings etc and you have an upside down healthcare
industry.
How many times do you see an ad for a new medicine that
deals with a certain condition (I chose the word condition on purpose) and yet
there is a monstrous amount of side affects you need to worry about. And think
about this, they are advertising these new drugs heavily. To me it seems they are selling you the
condition so you have to buy the medicine. Yeah there are medical problems, but
if you are seeing ads how prevalent is the condition or how much do they have
to sell it. You would think that if people had the condition or illness that a
doctor can make a reasonable assessment of your condition and decide what if
any medicines you may actually need. Most pharmaceutical companies send drug reps
out to the doctors, why the heavy ad blitz.
Again think meeting wall street expectations.
Obviously I am dealing with a market place healthcare system
and not socialized medicine, yet that does not mean that we put the cart before
the horse. You are more important than the health of a company. If they cannot
manufacture what we truly need in medicine, what are they manufacturing. The
doctor should make the decision what is needed not late night TV. So the
pharmaceutical companies should not be measured by Wall Street expectations,
but by ours. I think we need private market companies because they will make
the effort to find the medicines and products we need in a more competitive and
efficient manner, but the true healthcare market should be the driver of need.
And then there is insurance and this is where Medicare comes
back into this writing. And many of the same arguments as above exist for
insurance. Wall Street does not need to be the driver of expectations for the
measurement of these companies’ success. The driver should be the patients’
needs. And the discussion could branch out in many directions from here, such
as health, eating habits, holistic medicine, etc which I am going to brush
aside and just talk about insurance. What should we reasonable expect for
healthcare and how much is our responsibility and how much should society
contribute. And of course the flip question is, should society even contribute.
We already answered the question when we created Medicare. At this point we
feel it is a combination of govt. management and individual contribution. There
is a whole separate payroll deduction. Is this insurance? Conceptually it is
not suppose to be, however, we have now added buying insurance to supplement
Medicare and we treat it as insurance in some ways.
Do we truly combine Medicare into an insurance policy and
pull it completely out of social security and maybe even out of the government’s
hands? Do we create insurance policies
for life via Obamacare? I do not think we can answer these questions or any
similar ones till we pull special interests out of Washington and the
discussion. This is where democracy or at least the way our country should run
should apply. The interests of the people in certain arenas such as healthcare have
to take precedent over any individual interests where it be a locale or a
business or organization.
So step one to truly reform Social Security and Medicare
begins with overhauling special interest and Congress. Step two for Medicare is
defining what we really need in healthcare. Can we continue to contribute
through the current payroll system into a mass pool and have it meet the needs
of our society’s healthcare needs for the elderly? One answer exists because we
had to create Medicaid.
One answer is to create socialized medicine and implement
price and care controls defined and regulated by the government. This to me
will actually be more expensive in the long run than reigning in Congress and removing
Wall Street and the companies’ influence on legislation
Step three is the details. And I mentioned one option above
and that is insurance for life. So does that mean we never contribute to
Medicare again and just have one premium and carry it with us. And can we shop
insurance companies like auto or home to get the best price possible. Do we continue
to rely on employers to help foot the bill as part of the benefit package of
working for a company? Many employers are also strapped as to paying
healthcare. And this leads me to some confusion, you would think employers
would be the largest voice on Capitol Hill to reign in insurance costs, yet it
doesn’t seem to be a priority for them.
Do we continue with a two deduction system? One deduction is
for our health insurance through our employer or our payments to a private
insurance company directly and then the Medicare Tax withholding for future
use. Can we put aside Medicare money like we put aside retirement money? How we answer healthcare reform will have an
impact on how we make these decisions.
Do we go back to one deduction for Social Security, prepay
insurance with it and when we receive benefits we automatically have Medicare
which is what most people going into retirement think is going to happen. And
if we keep the 80/20 responsibility how do we help people prepare for
retirement so they can afford the 20% of their share of healthcare costs? And
by reducing costs overall would this mke the 20% more palatable to a retiree’s
budget? Could we create a lump sum Medicare savings plan? And if so do we
create a pool trust or individual accounts? Is it all individual contributions,
which probably will not fly since some people would use it more than others.
Which unfortunately circles back to what I wanted to brush off, how much responsibility
does a person have in taking care of themselves or government regulating their
care if society is going to contribute to some of each individual’s healthcare
and healthcare costs.
These are some of the questions and some proposals offered
in discussion for the Medicare portion of what do we do with Social Security.
If you have managed to struggle through to this far you realize health care is
a monster that needs improvement for us now and into our retirement. And as
previously mentioned Obamacare did not resolve the core problem of health care
costs and ultimately how much is our and our society’s responsibility. Medicare
is not a stand alone issue to resolve.
Can we do the same for Medicare contributions we might do
for the retirement portion and invest it? Heck you could even use Medicare to
invest in the same insurance companies etc that profit from Healthcare,
somewhat of a push me pull me relationship to the cart and the horse. The final
problem is balancing the amount of government intervention into the whole
healthcare system and determining our responsibility for ourselves. None of
this is an easy feat.
Part three will be about the social welfare aspect and then
part four is hopefully a concise recap of ideas and proposals discussed.
No comments:
Post a Comment