Catherine Rampell devotes her Washington Post column to arguing that Sen. Sanders’s health care reform plan is an exercise in signalling how virtuous he and anyone who supports his plan are:
Given Americans’ allergy to higher taxes, it’s not enough to dismiss fiscal concerns by assuming Americans will gladly give Uncle Sam the money they currently earmark for a private health insurance system.
On this and other major questions, the Sanders plan punts. Anyone who asks such questions, or raises an eyebrow at the lowball estimates cooked up by the Sanders camp, gets branded a wet blanket, a heartless technocrat, a corporate shill or worse.
The goal should be universal health care, however we get there. And we’re much likelier to get there if we start from a baseline of reality than if both parties hand-wave away inconvenient truths. There is no courage in saying everyone should have health care. The courage is in staking out a plan to pay for it.
One way of beginning that process is by defining what is meant by “universal health care”. What is “universal”? Everyone? Every citizen? Everyone in the country legally? If your answer is “citizens”, you’ve already discounted nearly 15% of the people in California, the most populous state in the Union and, consequently, the most influential.
What is meant by “health care”? Everything that patients may want? Everything they need? Who decides what they need?
Some market basket of defined care? Who decides what goes into the basket?
These are hard questions. Handwaving is ever so much easier than answering them.
But to begin with, how about some basic accounting?
We pay for it by spending.
You see no risk of a loss of confidence in the dollar? Health care spending is rising far, far faster than GDP. I think that we could spend more than we take in indefinitely without serious repercussions as long as what we spend is limited by what we produce. You’re talking about something a lot different from that.
Not from spending. Loss of confidence in the dollar is happening and will continue to happen because our government is weaponizing the currency and threatening anyone who doesn’t precisely toe the line.
“Universal” is universal. If you’re in the country or a citizen of this country temporarily outside our borders — businessmen, tourists, servicemen — you’re covered by the basic American healthcare plan. It’s like breathing the air — there are EPA standards that are supposed to apply everywhere, and no one claims its good and proper that poor children cough with every other breath.
That’s my conception, anyhow. The actual issue is what the limits are on a “basic” plan. Let’s recall that the greatest chunk of our heath care spending nationally isn’t dealing with childrens’ illnesses but with the last year or so of elderly peoples’ lives, particularly for those afflicted with Alzheimer’s. schizophrenia, or other dementia, those immobilized in old folks homes, etc. If we could just figure out how to pay for that last year or two of old peoples lives, dealing with the other cost issues of universal health care would be much simpler.
I’ve a suspicion — hell, an expectation — that abortion and maybe gene therapy is going to reduce the numbes of patients with schizophrenia and Alzheimer’s syndrome and probably a dozen other long term debilitating conditions are going to drop considerably in the last half of this century. So “universal” medical care will become much more affordable as time goes on.