Latest posts by Jane M. Orient, M.D. (see all)
- SOTU 2019 and American Medicine - February 12, 2019
- So What If ACA Is Unconstitutional? - January 8, 2019
- Epidemics, Fear and Denial: How Every American Is Threatened - December 11, 2018
The Republicans are at it again: trying to tweak a bad idea, make it “bipartisan,” and set a flawed system more firmly in concrete. What we really need is a Republican reform – one that can restore the republic, along with medicine.
Yes, Obamacare needs to be repealed – every last syllable. But that’s not all. To make America and American medicine great again, we need to remember what made it great in the first place. It was, to quote Dinesh D’Souza’s great insight in his book “Stealing America,” the “anti-theft” society. That’s what attracted people like him from all over the world, including India, to come here and become great Americans. They certainly did not risk everything to come to America and turn it into what they had left behind.
To put what we need to do into a few words: Stop the lying and the stealing. Simple. But far from easy. Once a country has become addicted to theft – redistribution of wealth – it’s hard to stop it. Almost everybody has something to lose, and the benefits are hard to see.
The benefits of stopping the plunder could include:
- An immediate 15 percent raise for all working people;
- A big increase in job opportunities;
- An enormous drop in the price of medical care (50 percent or more);
- Timely access to a doctor who is happy to see you and has plenty of time for you.
Does that sound worthwhile?
To get there, we have to get to the root of the problem: the tax code and Medicare. During World War II, wage and price controls made it hard to find workers, so companies started paying in tax-free medical benefits. More and more medical care was paid for through third parties (“insurance companies”). Then came Medicare – for the people who needed the most care – which paid through government and its private partners, such as Blue Cross, which administered the system. Prices doubled or tripled overnight.
My first proposal is to stop the Big Lie of the Social Security/Medicare system and abolish the payroll tax. There’s the 15 percent pay raise. The employer’s “contribution” has to come out of the worker’s earnings, too. Without the added expense of payroll taxes, more employers could hire more people.
The payroll tax is a first-dollar tax. No one can (legally) earn a dollar to buy milk for the baby or bus fare to get to work without paying 15 cents to Social Security/Medicare. And no, it is not a contribution to an individual’s retirement, even though it is represented as such. It is just a tax, as the U.S. Supreme Court determined long ago. The worker has no legal, contractual claim on any return at all. He’ll get whatever Congress allots when he reaches retirement age. Minorities with a shorter life expectancy will end up getting less. When the government runs out of revenue – pyramid schemes always run out of enough new subscribers – that’s just too bad.
The worker’s “contribution” is immediately spent – on other people’s retirement or medical care (some of them very rich). And also on the well-compensated army of white-collar employees who shuffle the money around. Probably half or less of the revenue that comes into Medicare is spent on medical goods and services.
But what would we do without Medicare, or other “insurance”? How could we afford care? Well, if you can’t afford to pay for something, how can you afford to pay two to three times as much by passing the money through a third party?
Some people seem to think that enrolling in insurance is like the scene in “Laurel and Hardy” where Stan, faced with the lunch bill, puts his last nickel in the slot machine and hits the jackpot. Yet people know that slot machines aren’t a magic money-multiplying machine.
Insurance is a way to voluntarily share unpredictable but catastrophic risks. It is not a way to get other people to unwillingly pay your bills. Neither Obamacare nor Medicare is really insurance. In fact, they outlaw true insurance for medical care and force most people into a beggar-thy-neighbor prepayment scheme.
Of course, we cannot suddenly cut off payments to older people who relied on politicians’ promises. But they will be hurt more than anyone else if we allow the American system to collapse.
Obamacare loots Medicare to help fund the scheme. Some Republican proposals would impose Medicare risk-adjustment methods on the whole economy – without admitting that the system is insolvent.
We need an Operation: Restoring Honesty. Major surgery, not a tummy tuck. It should start with Medicare.