A Necessary Digression

“We the people of the United States, in order to form a more perfect Union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.”

We recognize the preceding words as the preamble to our national Constitution. We’ve heard them in whole or in part throughout our lives, but as I listen to the conversations around me, as I read and answer comments to my own essays, it seems to me as if these ideals have become nothing more than words on a page. We see them. We read them. We say them. Yet we don’t seem to truly grasp what they mean. The intentions of the men who wrote these words so many years ago have been lost in the sea of prosperity and personal gratification so that they no longer hold the same promise that they once did. Or rather, the promise is still there, but the readers no longer believe in it. The importance of understanding these ideals is paramount if our chosen form of government, self-rule, is to endure.

We The People These first three words are the most important words in the entire preamble because it is with these three words that our form of government is established. We the people. Say it out loud and let it roll across your tongue. We the people. It couldn’t be any simpler to understand. We are our government. We are the ones responsible for making the decisions. We are the ones responsible for accountability. The government is us. From a practical standpoint, this is even truer today than when the framers wrote these words, for in their time, women couldn’t vote, non-whites couldn’t vote, often the poor couldn’t even vote. But as we’ve intellectually matured as a group, these inequities have been remedied and today, every adult American citizen has the chance to speak their mind about the workings of government, through their votes and their voices. But we don’t. It is time to quit thinking about government as an entity apart from the people, because in doing so, we establish a rivalry when one should never be.

From the left and from the right and even from the politicians, we hear how we can’t trust the government with this or how we need the government for that or how the government screwed up this or lied about that. We love to trash our elected leaders and advance their cynicism through decisive but utterly trivial matters while turning a blind eye to overt dereliction of political duty and outright corruption. We choose our leaders with one and a half eyes closed, and then keep sending them back regardless of their dedication to serving the citizens of the land. And the really sad part is that those doing the choosing barely represent half of the Americans whose voice should be heard. And the cycle is a self-perpetuating one. Less direct participation means less understanding, leading to less interest, accountability, and trust, which leads to further alienation, completing the circle. Mostly through apathy, We The People have abdicated our self-determination and bemoaned its loss in the same breath, and now we are left in two camps. One camp distrusts all things governmental and won’t have anything to do with it, including voting, except when they somehow personally benefit. The other camp distrusts all things governmental too, but gets out and votes for one side while spewing vileness at the other. With just over half of half of the population deciding which ideology will rule the day, We The People does not live up to its potential.

The other parts of the Preamble provide a course of action for our government to follow. “In order to form a more perfect Union,” implies compromise when necessary to further the goals of society in ways that benefit the greatest number of people. Promoting “justice, domestic tranquility, common defense and general welfare” outlines the established parameters for our government to work within, and “to secure the blessings of liberty to ourselves and our posterity” instills in us the duty to balance the benefits of today’s decisions with the consequences for tomorrow’s public. But in the light of today’s political environment, compromise is considered a sign of weakness, promoting the common good is passé, and forward thinking is a waste of time. This is what happens when We The People separate ourselves from our government. Without We The People, the whole thing just sort of falls apart.

Sitting around complaining about the failings of government can be a productive thing, but only if it leads to action to fix the problem. Yet in the charged political climate we find ourselves in, new ideas are torn apart without examining their merit while each side accuses the other of stonewalling. We look at this mess from afar, thinking we can’t possibly make a difference, but to think that is wrong. We have a voice. We have to use it. It is preposterous for any political party to lay claim to having a mandate from the people. They could at best claim a slim victory between the most vocal. But imagine if every eligible citizen turned out to vote and let his or her voices be heard. All these previously unheard voices would need someone to represent them and their needs, bringing more variety into the political arena, more opportunity for real representation, more willingness to try new ideas, to fix the status quo when it needs fixing.

By its very nature, politics is powerful. But it should not be about having power. In selecting people to make our collective decisions for us, we entrust them with our daily lives. Such trust should not be taken lightly, but it is because low citizen participation ensures easy reelection and low accountability. It is time for that to end. It is time to let our voices be heard, all of our voices. We hold our election process up to the world as the model which to follow, and brag about mandates with 50% or less of eligible voter turnout. Then we turn around and mock as “banana republics” those countries whose voter turnout is in the 60% range. Am I alone in seeing the hypocrisy of this? As we continue the slide towards apathy, the situation will only get worse, with fewer and fewer people making the decisions that affect us all.

So where do We The People go from here? First, make sure that you vote, especially in federal and state elections. Encourage others to vote or help get people registered. Talk to each other. Think about solutions to our shared problems instead of tearing apart new ideas because “the government can’t be trusted.” If we don’t trust our government, we are really saying that we don’t trust each other or ourselves. Find people you can trust and help get them elected. After all, our elected officials are raised in our communities and are supposed to share our values, values that have guided us for generations even as they continue to evolve. Leave the political party machines that depend on your fears and mistrusts to stay in power. Support people who will truly stand for the values laid out in the Preamble to our Constitution. By putting ourselves back in the driver’s seat, We The People can revive the trust in self-government, tear down the wall we’ve created, and get back to establishing justice, insuring domestic tranquility, providing for the common defense, promoting the general welfare, and securing the blessings of liberty to ourselves and our posterity as we were set out to do.

Affordable Health Care Does Not Mean Free Health Care

Proponents of comprehensive national health care fall short of the mark when it comes to proposing an equitable plan to pay for it. Naturally, the first thing we can do about making sure people can afford health care is to reduce the entire price structure, focusing medicine back on care and less on profit. And, just as importantly, we must aggressively prosecute those individuals or companies that perpetuate fraudulent billing claims, enriching themselves while robbing the system of needed finances. These measures will help decrease the costs of health care considerably, as do many of my suggestions in the preceding three essays. (Strangely, these are not areas that are focused on; instead regulation explores areas to cut care rather than rein in costs.) But the fact remains that health care is still going to cost money, and it should be a shared responsibility between the general public and the health care industrial complex. Citizens must shoulder the costs for their own well-being and medical care, but the industries that depend on sickness to survive should also establish a public trust to help defray the costs of long term or catastrophic illness. At the same time, medical costs must be kept within financial reach for all legal citizens, regardless of their actual income level.

First, we need to have a more clear vision of what a reasonably healthy person’s annual medical costs may be. Simply a random ordinary citizen, with one medical physical a year, two dental cleanings a year, and one vision check a year, even at $200 per visit, the annual bill is around $800. Let’s throw in a few random blood tests, two cavity fillings, a pair of glasses and a pair of contacts- roughly $700. Finally, we’ll add various medicines, both over-the-counter and prescription drugs at $200. Annual total is $1700, or $142 per month. Now honestly, most people go years without cavities or blood tests, or even eye doctor visits and physicals. Their annual costs could be much lower, assuming that no catastrophes occur. (These dollar figures are estimates and for illustrative purposes only. Actual costs may in fact be much higher due to rampant greed within and without the industry.)

The simplest solution is a national health tax; the collected funds being deposited into a publicly administered and managed account, and disbursed according to well defined guidelines. The tax itself could be collected in several ways, to better ensure that all citizens are contributing to the fund according to their financial ability. To start, every legally employed citizen would deposit in to the system a percentage of their earnings, deducted from their regular paychecks, pre-tax. The formula for determining the percentage each person pays could be derived in several ways: basing it on an average annual medical cost of a healthy person at their age; by dividing the total population by the total national health care bill to arrive at a per capita figure; using the percentages from either of the former equations and developing a sliding percentage scale further based on actual income. And we’d need to figure in the costs for children and retiree coverage, since they are not in the workforce but will still need care. Any formula will be imperfect in the goal of attaining universally affordable health care, simply because the word “affordable” is such a relative term. But some such formula would need to be agreed upon that best reflected equitable terms for the largest number of citizens.

For those who can, but for whatever reasons do not (stay-at-home parent comes to mind), have regular employment, the health tax could be collected from the primary worker’s pay or through an annual tax payment, similar to today’s income tax. Or, more creatively, these citizens can recoup their health costs to the system by working in the system as orderlies and assistants for a fair hourly wage, the earnings of course being returned to the tax fund to cover their annual contribution rate. Such a barter arrangement should be limited to those not in the established workforce, to ensure a continued influx of actual cash from those who are, but would further reduce the overall operational costs of health care in general.

In return for paying the health tax, citizens would enjoy free office visits and aid from their neighborhood clinics, discussed in the previous essay, “The Doctor Will Be With You Shortly.” Vaccinations, minor stitching, first aid, and minor aches and pains would be treated as needed and would require no co-pays or material costs. Also included at no cost to patients would be basic pre-natal visits, bi-annual dental exams and cleanings, and an annual vision test if needed. Provided the medical matter could be resolved within the neighborhood clinic setting, citizens could help control costs for themselves and the system overall by learning what requires a doctor’s attention and what does not. The neighborhood clinic is the first barrier in the war to controlling costs, which it does by both handling minor, non-emergencies and by educating patients to recognize real medical problems from over-hyped non-issues. Also covered by the national tax would be annual medical screenings at your primary personal physician.

Patient costs would move beyond the national tax and into the fee-tax arena once their sickness went beyond the scope of the neighborhood clinic. Any visit to a personal primary physician, except for an annual preventive screening, would require a co-pay and a materials fee, again based on a formulaic percentage of some sort, but with a maximum ceiling and a consistent, reality based materials cost list. For those citizens unable to manage these costs, a no-low income safety program paid for in part by the public trust fund established by the health industry would cover these costs.

Finally, catastrophic medical situations could be paid for through a higher co-pay, based on procedure rather than on a standard admission fee, and adjusted according to an equitable formula. In addition to the co-pay, the patient would be responsible to pay up to 50% of the actual costs of the medical procedure, up to a maximum out-of-pocket expense, but would be allowed to negotiate a no-interest, long-term, no penalty, flex pay installment agreement. Such an agreement could not be used to foreclose on any citizen’s property or garnish of their wages too severely, provided the citizen maintained communications with the fund administrator. At the same time, citizens trying to evade their medical bills with malicious intent should be brought to justice and forced to repay, this time at the terms of the courts.

With regards to medications, cost control measures could be applied so that common remedies are readily affordable while designer drugs are much more expensive. Medical necessities like crutches, wheelchairs, and other reusable items could be rented for low daily or weekly fees, paid entirely by the patient, with the money being recycled into the system to perpetuate itself indefinitely.

The national health tax would pay the actual costs of maintaining the nations health system, from buildings and administration, to doctor’s fees and diagnostic and treatment costs, as well as to continue ongoing discovery and cures. But it would not pay for any type of elective surgery; doctor assisted suicide, or non-medically necessary abortions. Patients succumbing to the vanity medicines like elective plastic surgery or enhancement or magic libido potions should be required to foot the entire bill for these procedures, and at elevated costs and perhaps even be subjected to a vanity tax as well.. Provided that the procedure is not a necessary element of some greater illness or accident, elective surgeries like these use up valuable medical resources and should really belong in a private field of medicine, completely removed from a national care plan. The same is true for doctor-assisted suicide, since the issue raises serious questions for people of differing faith. While the option should be available for those who want it, they should not rely on commingled tax dollars to pay for the costs. And really, how much can a few pills really cost? Finally, non-necessary abortions should be paid for by the patient, unless in case of medical necessary or verifiable rape or incest.

Contributions by the health care industry to a public trust fund would help defray costs incurred by expensive, life saving operations, long term-care for patients, and no-low income patients. In return for their contributions to the fund, they would receive generous tax breaks that could be reinfused into their R & D programs. They could receive specific supply contracts to ensure a steady flow of business. And all businesses, save for the insurance industry, would benefit by not having to pay health costs for employees and their families, something only fair if the National Whole Life Retirement Plan were to be adopted, as businesses would be solely responsible for funding the basic level of the nation’s retirement program.

The ideas presented in this four part discussion on medical care are a starting point, not necessarily a final answer. But taken together, they represent an effort to move outside the current environment of greed and profit above all else. Medical care is something we all need at some point in our lives. We should never expect a free ride, but we should also never have to fear that the costs of getting care are out of reach.