It’s very frustrating to watch people intentionally and unintentionally mangle the language of the proposed health care bills in Congress.  The fact that there isn’t even a bill yet makes it even more frustrating.  The loudest voices are often the ones with nothing to say, so every day we get to watch ravenous crowds relate expanding health care coverage to Nazi oppression.  You’d think we were invading a country or something.

Politicians aren’t helping either.  Sen. Chuck Grassley (R-IA), whom I normally like, has been giving town hall meetings all week under the pretense of warning people about their impending doom.  Despite being very rational and cooperative for the last few months, he’s now telling his constituents they ought to be afraid about programs that might “pull the plug on grandma.” I understand and support his opposition to a single-payer plan, but his language over the past few days very obviously states that his true goal is having no plan at all.

The Democratic plan(s) are all over the place right now so it’s difficult to get a clear idea of what they are going for.  A purely public system?  A public option to compete with the private insurers?  Or should we just subsidize those who can’t afford insurance so they can buy into a private system? Thankfully, a large number of liberal Democrats have given up on the universal health care model, which should make the whole deal more palatable.  Given the violent responses at these town hall meetings though, it’s difficult to predict if any Republicans have the guts to support any reforms at all.

The Republicans disagree over their own proposal as well.  The fundamental idea – keep health care portable and privatized while providing more options – seems sound and doable.  But the proposal offers no way to pay for it.  It specifically states that it won’t raise government spending, and will cut taxes to help individuals pay for a plan of their choosing.  Quixotically, it also calls for certain expansion of government, including a joint health care task force amongst agencies and a Health Savings Account program.  Who is going to manage the new HSAs?

My view of health care is less about moralistic grounds and more about cost and efficiency.  With this in mind, universal, government-run health care is the best option on paper.  Many liberals like to compare the deficiencies of our system to the social welfare programs in Europe, but I think Japan is a more adequate measuring stick.

Japan and America are both capitalist nations with high populations.  The United Nations Human Development Index reports that America spends 15.4% of our GDP on health care, or about $6,000 per person.  Japan spends about 7.8% on care, or $2,300 per person.  Japanese live, on average, to age 82 while Americans live to age 78.  Part of this particular discrepancy is the difference in diets, since Americans tend to be a little on the obese side.

So, what do you get for about 1/3 of the cost?  At least 70% insurance.  In Japan, you’re responsible for up to 30% of the remaining cost, but this is adjusted by income level and has an upper limit attached.  Emergency room visits are likely to cost more, but you’re still only responsible for 30% at most.  You choose any clinic you like, and pick up the drugs you need while you’re there.  Of course there are problems in coverage gaps, but nothing worse than in America.  Taking health care costs off the backs of corporations means they can pay higher wages (building positive consumer demand) or charge less for their products (making Toyotas that much more attractive).  Because the insurance is also portable, Japanese citizens can switch jobs while keeping their doctors and same levels of care.

There’s a strange current in America that public health care will lead to fewer doctors or less selection, but it seems like the Japanese system offers increased flexibility, if anything.  Japan does have fewer doctors than America; about one for every 200 citizens, compared to one for every 250 citizens in the US.  However, this is a misleading figure.  There are also 200,000 practitioners of traditional East Asian medicine, who are highly regarded and consulted for many small ailments.  In sum, Japan is a country with a very large population that still manages a public health care plan.  It’s cheap, and people can buy private plans on top of that if they want greater options.  This system will probably never happen in America, but it would offer us significant savings in government expenditure.

So, what plans will actually work?  Several, and they’re all marked improvements over what we have now.  I will try to be as succinct with these as possible, but of course you could spend years reconfiguring and analyzing these.

First, a competitive public plan.  Create a non-profit insurance company, owned by the government, that offers insurance plans at a reasonable cost.  Conservatives have slammed this plan, because they feel the government plan will immediately have an unfair advantage over the private plans.  This may be true, but let’s look at some of America’s top universities.  Harvard, Yale, and Princeton are thought to be the top three universities in America and the world.  All are private and charge steep fees for tuition.  Yet this doesn’t stop thousands of students from applying there each year.  On the other hand, we have fantastic public universities too.  Berkeley, Michigan, and Virginia are three world-class universities that are government-owned and extremely competitive.  If we want to follow this university model directly, have government hospitals compete with one another on these terms.  There is no reason why we can’t create a competitive public plan that’s fair to private companies while providing high quality service.  Harvard isn’t going out of business anytime soon.

Second, a “5-year rule.”  Write a law that says the insurance companies they have 5 years to insure the entire country with a reasonable level of insurance.  Aim for 95% insured rate or higher.  If 5 years expire and there are still millions of uninsured, then the automatic law will require a government plan be created.  The insurance companies will adjust, or face serious competition.

John McCain’s plan, which seems really strange to me, is to disconnect the employer element from health care.  Individuals will receive a tax credit and can shop around for plans at will.  But that ignores the chief benefit of employer-based care: buying in bulk.  I pay 25 percent of my health care costs right now.  If my employer did not pick up the rest, I’d be paying close to $5,000 per year for a very basic plan.  Of course the real cost would be much higher, since I wouldn’t get the bulk discount.  Unless we plan on legislating how much an insurance company can charge for care, this is a messy solution.  Still, it suggests an expansion of coverage, which is certainly better than nothing.

Overall, I am shocked by the negative backlash related to health care reform.  Would these angry folks prefer we change nothing?  What do they have to say to the 47 million without care?  Tough luck?  I refuse to believe that Americans are that selfish.  There are plenty of mostly-private options that are being seriously discussed, but these angry mobs are attacking anything with “reform” attached to it.  I am fearful that Congress will be afraid of the extremely vocal minority that has no solutions of their own.  The best way to counter a bad idea is with a better idea, and logic would suggest you’re bound to lose with no idea at all.  These crowds aren’t logical though, and should be ignored.  When Congress reconvenes in September, I sincerely hope they can move past this unwelcome distraction and get down to fixing health care.

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