OPINION — A modest healthcare proposal

By SHELDON RICHMAN

Enough dithering! President Obama says it’s time to act on healthcare. I agree.

But act how? Are we really going to be happy with the pussy-footing proposals floating around Congress? All the so-called reformers want to do is tinker with insurance regulations. But how effective would that be, considering that the insurance companies themselves support the changes?

We have taken our eyes off the ball, people. Let’s get back to first principles. Obama’s premise is that we have a right to healthcare. A right.

America was founded on the idea of rights — inalienable rights. No one can take them away. I assume that when people say that healthcare is a right, they mean that healthcare is an inalienable right.

Obama apparently agrees. In his speech before Congress he called for free services, such as physical exams, colonoscopies, and mammograms. Free! You have a right to those things.

Well, okay. But why stop at free preventive services? Why not free treatments, free surgery, free drugs, and so on? We need those things as much as a physical exam.

If we have a right to healthcare and if we are unable to obtain those services, our rights have been denied or violated. That is something the advocates of healthcare “reform” say we must not tolerate.

Okay, let’s not tolerate it. Let’s make sure no one’s right to healthcare is violated. Let’s get serious for a change.

But how? I can think of only one efficient way to accomplish this. Let’s enslave the providers of medical services — doctors, nurses, paramedics, dentists, chiropractors, acupuncturists, psychiatrists, and the rest.

My proposal may shock people, but I am confident that this feeling will wear off as we think about how logically it flows from the principle that we have a right to healthcare.

First, let me point out that there is no other good alternative. Any other system designed to deliver healthcare as a matter of right will have gaps through which the least fortunate inevitably will slip. Isn’t that the problem we’re trying to fix?

Obama’s approach isn’t much better. He wants to force the insurance companies, with taxpayer subsidies if necessary, to insure everyone — healthy or sick, young or old — at the same price. He might even like a government insurance option, though he can’t make up his mind whether or not that is an essential feature of his plan.

Regardless, it’s a bad plan. Requiring insurance companies to pay for our medical care misses the point. Where do you think insurance companies get their money? From us! What kind of right to healthcare is it if we end up paying for it anyway? Obama means well, but his plan is a shell game.

On the other hand, enslaving the doctors and other providers would have none of the defects of the current system or the leading reform plans. It goes right to the source. We have a right to healthcare? Fine. Force the doctors to provide it.

Of course, this wouldn’t be free. I’m no pie-in-the-sky utopian. The doctors and the others would have to be fed, clothed, and housed. They’d need certain comforts. That’s understood.

But it would be far easier to keep a lid on costs by enslaving the providers than by the patchwork system we have now, or would have under Obama’s plan.

The biggest problem I can see is that if doctors are going to be our slaves, no one will want to be a doctor. Most people don’t relish the idea of being slaves even in the national interest. They’re selfish that way.

We certainly can’t be a world-class country without doctors and nurses, so I have a solution to this problem: conscription.

President Obama should direct the nation’s schools to look out for students with an aptitude for biology and direct them into medical studies. Then at the appropriate time, the government should draft those young people into the newly created U.S. Medical Service Corps.

I know what you’re thinking: As word of this got around, the best students will play dumb. If that happens, we’ll have no other choice than to pick our doctors by lottery.

(With apologies to Jonathan Swift.)

[Sheldon Richman is policy advisor to The Future of Freedom Foundation (www.fff.org) and editor of The Freeman magazine.]

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Submitted by Insayn on Thu, 09/17/2009 - 10:05pm.

"America was founded on the idea of rights — inalienable rights. No one can take them away. I assume that when people say that healthcare is a right, they mean that healthcare is an inalienable right."

Tell me where in the Constitution, Bill of rights, Emancipation Proclamation, or recipe for Twinkies it says we have the right to healthcare provided for us by Government?

Life, Liberty and Pursuit of Happiness? NO. There was no such thing as health care in 1776 or 1800 or 1850. You paid the doctor you six pense and a bottle of jack and he went on his way to the next un-anesthetized lobotomy. The Founders were not speaking of health care as the "Life" part in that little document, but were saying the king cant just say off with your head because your a peasant.

Its sad that this has become such an issue that everything else on the planet, except for Michal Jackson, is being ignored.

suggarfoot's picture
Submitted by suggarfoot on Thu, 09/17/2009 - 2:26pm.

Paul V. Dutton
France's model healthcare system
By Paul V. Dutton | August 11, 2007

MANY advocates of a universal healthcare system in the United States look to Canada for their model. While the Canadian healthcare system has much to recommend it, there's another model that has been too long neglected. That is the healthcare system in France.

Although the French system faces many challenges, the World Health Organization rated it the best in the world in 2001 because of its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and longevity of the country's population. The United States ranked 37.

The French system is also not inexpensive. At $3,500 per capita it is one of the most costly in Europe, yet that is still far less than the $6,100 per person in the United States.

An understanding of how France came to its healthcare system would be instructive in any renewed debate in the United States.

That's because the French share Americans' distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as "socialized medicine." Virtually all physicians in France participate in the nation's public health insurance, Sécurité Sociale.

Their freedoms of diagnosis and therapy are protected in ways that would make their managed-care-controlled US counterparts envious. However, the average American physician earns more than five times the average US wage while the average French physician makes only about two times the average earnings of his or her compatriots. But the lower income of French physicians is allayed by two factors. Practice liability is greatly diminished by a tort-averse legal system, and medical schools, although extremely competitive to enter, are tuition-free. Thus, French physicians enter their careers with little if any debt and pay much lower malpractice insurance premiums.

Nor do France's doctors face the high nonmedical personnel payroll expenses that burden American physicians. Sécurité Sociale has created a standardized and speedy system for physician billing and patient reimbursement using electronic funds.

It's not uncommon to visit a French medical office and see no nonmedical personnel. What a concept. No back office army of billing specialists who do daily battle with insurers' arcane and constantly changing rules of payment.

Moreover, in contrast to Canada and Britain, there are no waiting lists for elective procedures and patients need not seek pre-authorizations. In other words, like in the United States, "rationing" is not a word that leaves the lips of hopeful politicians. How might the French case inform the US debate over healthcare reform?

National health insurance in France stands upon two grand historical bargains -- the first with doctors and a second with insurers.

Doctors only agreed to participate in compulsory health insurance if the law protected a patient's choice of practitioner and guaranteed physicians' control over medical decision-making. Given their current frustrations, America's doctors might finally be convinced to throw their support behind universal health insurance if it protected their professional judgment and created a sane system of billing and reimbursement.

French legislators also overcame insurance industry resistance by permitting the nation's already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by Sécurité Sociale. Indeed, nearly 90 percent of the French population possesses such coverage, making France home to a booming private health insurance market.

The French system strongly discourages the kind of experience rating that occurs in the United States, making it more difficult for insurers to deny coverage for preexisting conditions or to those who are not in good health. In fact, in France, the sicker you are, the more coverage, care, and treatment you get. Would American insurance companies cut a comparable deal?

Like all healthcare systems, the French confront ongoing problems. Today French reformers' number one priority is to move health insurance financing away from payroll and wage levies because they hamper employers' willingness to hire. Instead, France is turning toward broad taxes on earned and unearned income alike to pay for healthcare.

American advocates of mandates on employers to provide health insurance should take note. The link between employment and health security is a historical artifact whose disadvantages now far outweigh its advantages. Economists estimate that between 25 and 45 percent of the US labor force is now job-locked. That is, employees make career decisions based on their need to maintain affordable health coverage or avoid exclusion based on a preexisting condition.

Perhaps it's time for us to take a closer look at French ideas about healthcare reform. They could become an import far less "foreign" and "unfriendly" than many here might initially imagine.

Paul V. Dutton is associate professor of history at Northern Arizona University and author of "Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France," which will be published in September.


Cyclist's picture
Submitted by Cyclist on Thu, 09/17/2009 - 4:40pm.

The French government is looking at ways to plug a gaping hole in its health care budget and may charge patients more for hospital stays...

After a 4.4 billion euro ($6.31 billion) shortfall in the health budget in 2008, Woerth said he expected the deficit to hit 10 billion euros this year and 15 billion next,.....

France spends 11 percent of its gross domestic product (GDP)...

The Socialist party denounced the reported plans to increase charges for hospital stays as "a tax on illness,".....

Concerns about the health budget are playing out against the backdrop of broader government financing woes,....

Read the rest of the story here.

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Caution - The Surgeon General has determined that constant blogging is an addiction that can cause a sedentary life style.


S. Lindsey's picture
Submitted by S. Lindsey on Thu, 09/17/2009 - 4:42pm.

Socialized Medicene has been proven to work.. Just ask Bunkie..

The American people will never knowingly adopt socialism.
But, under the name of “Liberalism” “they will adopt every fragment of the Socialist program, until one day America will be a Socialist nation, without knowing how it happened” Norman Thomas US Candidate for President


Submitted by Bonkers on Thu, 09/17/2009 - 5:59pm.

NOTHING (no program) makes money any more--doesn't even break even.
That is why we will soon owe 10-20 Trillion dollars at the federal level.
Somewhere along the line we will simply revalue the money or use some other tactic to flatten the debt. Or just refuse to pay the debt.

It has been going on for hundreds of years. Ever since we came out of the dark ages at least, where rulers did NOTHING for 90% of the citizens.
Budgets do not work (balanced ones)---ask most anybody in the USA of families who work for a living.

S. Lindsey's picture
Submitted by S. Lindsey on Thu, 09/17/2009 - 9:02pm.

but that's wrong... Just where do you or sweetfeet think France is going to get the money? TAXES or RATIONING there's choice for ya..

Can we say grannymoveon.org... "YES WE CAN"

The American people will never knowingly adopt socialism.
But, under the name of “Liberalism” “they will adopt every fragment of the Socialist program, until one day America will be a Socialist nation, without knowing how it happened” Norman Thomas US Candidate for President


suggarfoot's picture
Submitted by suggarfoot on Thu, 09/17/2009 - 9:28pm.

dont look for anyting new, or a way out...just accept your fate...

BUT DON'T TAKE ME WITH YOU...

I am old, I've always had health insurance, but before I leave this planet, I would like to see something better for the next generation...when you don't try...you don't get...if the thought process was left up to you...we would still be paying Great Britian our taxes and accepting our fate.

Me, I hope that when I look back on my life, I have helped myself, or someone else. I want to know that I tried...and didn't stick my head in the sand and accept crap as what I deserve..If you don't think any more of yourself...think of your children...do they really need to be leached by insurance companies? I want something better for mine.


suggarfoot's picture
Submitted by suggarfoot on Thu, 09/17/2009 - 9:42pm.

kissing the hewm of the dress of those who have it by you who don't...do you really think you should pay all this BS..for nothing except to keep up an industry that is eating you alive?

Sorry, I value myself and mine, more than that.


Submitted by lion on Thu, 09/17/2009 - 5:14pm.

Haven't you heard that Canadians, Brits, and the French are absolutely disgusted with their health care systems and are demanding a system like that in the United States?

It has been in all the news.

Or maybe not.

Actually most citizens of those countries seem quite happy with their health care systems. They view the American system not as a health care system but as a profits for insurance companies system with health care as a secondary concern. And with many citizens left out in the cold.

Most Americans are very ignorant about the health care systems of other nations. They seem content to just say since we are the United States we are the best in everything, including health care.

S. Lindsey's picture
Submitted by S. Lindsey on Thu, 09/17/2009 - 5:24pm.

Do a little research for Gods sake man..Git rid of the talking points and actually see what is being said out there instead of what you are being told..
In Reality they are moving TOWARDS Privatization instead of away from it..
Their cost are skyrocketing and are having to back away from the "Free" system..

I am wasting my breath.. I know pigs singing and all that..

...and yet another hit and run from "Drive by Blogger" Lion.. One day Lion might just hang around and defend those positions.. Odds of that.. about as much as I would give the "Public Option" Nill.

The American people will never knowingly adopt socialism.
But, under the name of “Liberalism” “they will adopt every fragment of the Socialist program, until one day America will be a Socialist nation, without knowing how it happened” Norman Thomas US Candidate for President


Cyclist's picture
Submitted by Cyclist on Thu, 09/17/2009 - 4:54pm.

You know that socialized medicine will work as long as someone else pays for it.
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Caution - The Surgeon General has determined that constant blogging is an addiction that can cause a sedentary life style.


S. Lindsey's picture
Submitted by S. Lindsey on Thu, 09/17/2009 - 5:10pm.

if this ever comes to pass.. Bunkie will still complain about getting no Healthcare while getting Healthcare again?

The American people will never knowingly adopt socialism.
But, under the name of “Liberalism” “they will adopt every fragment of the Socialist program, until one day America will be a Socialist nation, without knowing how it happened” Norman Thomas US Candidate for President


Submitted by Bonkers on Thu, 09/17/2009 - 6:06pm.

Oh, I got care alright!
4 blood tests for same thing.

Submitted by MYTMITE on Thu, 09/17/2009 - 8:36pm.

one each for three of your other entities? They were probably trying to find out what we on here have wondered for a long time---just what makes you, and you and you and you and you tick.

Git Real's picture
Submitted by Git Real on Thu, 09/17/2009 - 10:48pm.

They were testing DNA to see if it were possible that one of his "entities" was acutally not one of him... Hmmm... soooo confusing.

And the world struggles with the concept of the Trinity??? Wait until they try to figure our Bonker$ out. Laughing out loud

Obama.... The Bernie Madoff Of Washington


suggarfoot's picture
Submitted by suggarfoot on Thu, 09/17/2009 - 2:27pm.

under the bus! HO HO HO! I like it!


suggarfoot's picture
Submitted by suggarfoot on Thu, 09/17/2009 - 2:43pm.

Canada vs. USA
I'm a Canadian currently living in the US. I've spent 22 years in Canada and 27 in the US, so I have plenty of experience with both systems. Having said that, I can assure you that the Canadian system is far superior. The US system is an expensive nightmare by comparison.

In the US, I have lower taxes but I'm forced to deal with outrageous monthly premiums, fear of being dropped at any time, fear of losing my coverage if I change jobs, fear that my wife won't be covered because she had a benign tumor 10 years ago, etc. I also have to cough up "co-pays" for every office visit, must meet high deductibles (thousands of dollars out of pocket) before insurance even pays a penny, then have "lifetime maximum" limits on top of that - and the price just keeps going up every year. When it's all said and done, my tax advantage here has vanished.

Meanwhile, in my 22 years in Canada, I never once paid a penny for medical care. I had gall bladder surgery, spent time in ER for a badly cut hand, spent a week in hospital with broken bones from a motorcycle crash, had many trips to the family doctor with sick children - and NEVER had to wait any unreasonable amount of time - and certainly never paid a bill. Prescriptions are also half the price in Canada.

When you phone the doctor here, the first question they ask is "what insurance do you have?" When you phone the doctor in Canada, the first question is "What seems to be the problem?" This whole debate about which system is better is a non-issue to anyone who's actually lived under both systems. If I get laid off here (and lose my insurance), I can always go back to Canada - thanks God for that.


S. Lindsey's picture
Submitted by S. Lindsey on Thu, 09/17/2009 - 4:49pm.

sorta gives me gas.. My Boss is a Canadian Citizen.. She will tell you that you could not be more wrong. Her entire family still lives in Canada (unlike you) and they come to the US when in need of Medical care outside "ordinary" Doctors visits.. Any specialized care needed and on a waiting list they go.. In their case they can afford to come here.. We just hired another Canadian.. He just came in from Montreal..I have spoken to him at lenght over this.. He too would tell you.. you must have been gone for a long time... or NEVER needed any care over just a visit.
Take it for it's worth.. I just don't believe your version..

“FREE” Health Care in Canada. They say it’s FREE; it only costs you YOUR LIFE!

The American people will never knowingly adopt socialism.
But, under the name of “Liberalism” “they will adopt every fragment of the Socialist program, until one day America will be a Socialist nation, without knowing how it happened” Norman Thomas US Candidate for President


Submitted by AlarminglyCorrect on Thu, 09/17/2009 - 2:59pm.

Then go back. You are obviously here because you can't get a job in Canada. One friend, living in Sudbury, Ont. , I spoke with today, said she needed an MRI. The problem was "the MRI machine was broken" and she couldn't get the proceedure. "The" MRI machine, only one in a city of over 100,000 people. (I think Kabul, Afganistan has at least two MRI machines). I said come here, there are 20 within 10 miles of my house. She says an appointment at the doctor in Canada takes anywhere from 4 to 9 hours. Most Canadians with medical issues want to come to the USA. So, your praise of the Canada healthcare system should be re-checked because you must be thinking about it from all those years ago. I heard from this friend today.

suggarfoot's picture
Submitted by suggarfoot on Thu, 09/17/2009 - 2:51pm.

story dated Sep, 8, 2009

Three years ago, while I was traveling with students in France, we ate at a Middle Eastern restaurant. One of the female students developed what later was diagnosed as an allergic reaction (to tree nuts, it would eventually come out).

Within 30 minutes of leaving the restaurant, the young lady had developed hives, and a swollen tongue and throat. I accompanied the student and her mother to a local clinic in Paris.

By this time, the young lady was in terrible discomfort and the mother was frantic. The mother explained to the receptionist that she had insurance from the United States and had bought a supplemental policy for overseas travel.

The receptionist paused from typing in the information, peered over her half-glasses at the mother and gently said, "Never mind."

Within 20 minutes, the young lady was in an examination room and was being seen by a nurse, an intern and a physician.

An IV was started, and within a few minutes, the hives were gone, the itching and swelling had disappeared and our intrepid traveler was in fine spirits.
The doctor wrote a prescription for some medication and, since the following day was a Sunday and the pharmacies would be closed, he gave the girl some medicine to carry her over until Monday when we could get the prescription filled.

He bid us farewell, told the girl she would be fine, and sent us on our way. The total bill: zero.

The prescription cost 12 Euros, about $15 at the time.

I have been an advocate for universal health coverage for many years. Call it socialized medicine if you want, but I've seen it work.

Everyone in France is covered. No one is asked for an insurance card when they are sick or injured; no one is asked how they will pay. Studies have shown that the medical care system in France is one of, if not the best, in the world.

The French may not be too good at defending their borders, but they sure know how to set up a universal health care system that works.

It's way beyond time for this kind of system in America.

As for the young lady, she's just fine. She signed my yearbook with her name and, in parentheses under it, wrote, "The Tree Nut Girl."

PATRICK NOLAN,

educator,

Jacksonville Beach


mapleleaf's picture
Submitted by mapleleaf on Thu, 09/17/2009 - 8:17am.

The most intemperate among our citizens keep hammering about free healthcare, pointing out that it is never free.

Well-designed healthcare plans include deductibles and copays which preserve the incentive not to abuse the system. The basic idea is to prevent people from going broke if they have the misfortune of getting seriously sick or injured.

The basic Medicare plan includes deductibles and also a 20 percent copay. Virtually all insurance plans include deductibles and copays. I am sure all the plans being considered in Congress include provisions designed to deter abuse, and they are bound to feature deductibles and copays.

Hotheads out there should cool it. All you’re spreading is cynicism and misinformation, and you’re showing your lack of intelligence.


NUK_1's picture
Submitted by NUK_1 on Thu, 09/17/2009 - 8:27am.

The basic idea is to prevent people from going broke if they have the misfortune of getting seriously sick or injured.

If Obama and Congress simply focused on the above, this would be a far simpler issue. HB 3200 doesn't resemble the basic idea whatsoever as it is more interested in mandating to businesses, government involvement as a competitor/regulator/authority and jacking-up taxes on those who don't follow the government's wishes. Baucus' bill doesn't adequately address how the poor who can't afford ANY deductibles or co-pays are going to be subsidized, which a reasonable person would assume would be the FIRST thing a health care reform bill would address. First think Harry Reid said was "won't work in Nevada" Olympia Snow chimed-in with "this won't work in Maine." The disgust with the Baucus bill is coming from all sides. Time to start over because both HB 3200 and the Baucus proposal are awful and lack much support at all.


Submitted by Bonkers on Wed, 09/16/2009 - 7:43pm.

The Citizen has spoken.
No different health care, otherwise doctors, etc., will be treated as conscripts into the army.
They will be enslaved by Obama.
It is as if it is OK to treat someone for a $50 fee for a head cold, but if he unfortunately has cancer and has had it before, he must pay 100 times as much for his insurance!!!!! Which of course 90% can not do!

Can a cop let a good looking blond go free who was driving 110 MPH, but not a Mexican looking PhD ugly guy!
They were both born that way.

meanoldconservatives's picture
Submitted by meanoldconservatives on Thu, 09/17/2009 - 1:54pm.

"Richman (name says it all)"

How sad and disappointing it must be to live through the Civil War and two World Wars and be reduced to a life of petty jealousy. Wealth envy, class envy, insurance envy, FOX having the hot babes envy, etc., etc.


Submitted by MYTMITE on Wed, 09/16/2009 - 8:11pm.

handle say about you-----BONKERS????

Submitted by Bonkers on Wed, 09/16/2009 - 8:42pm.

Well I took that to be his "real" name.

People go Bonkers around here if a democrat shows up!

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