Battle4Liberty

There’s an elephant in the room on the health care issue—who pays for it.

This problem is illustrated in an exchange, a version of which I’ve heard several times this week:

Democrat: The health care plan passed by Congress doesn’t protect those with preexisting conditions.

Republican: It certainly does. The plan provides $100+ billion for high-risk pools so the insurance companies won’t have to cover these folks in the same plans with everyone else. That way, everyone else won’t have to pay for those with preexisting conditions.

Excuse me? Where does the $100+ billion come from? Republicans and Democrats alike talk as if such “pools” are created out of thin air. This approach is probably a modest improvement over the status quo, but someone must pay the bill.

People are simply demanding health care without a mechanism to pay for it. It’s time to call the bluff. Republicans should propose no frills, bare bones universal coverage to be financed entirely with a payroll tax (perhaps 5%) from all Americans—not employers—on personal income up to $100,000. If you opt for private insurance instead, 80% of the amount you pay in this new tax would be credited toward your premiums. While those who earn more would have to pay more, everyone would have skin the game.  Nobody would be excluded. Coverage, deductibles, and copays would be rationed accordingly.

I know my proposal is simplistic, but here’s the point: Democrats (and some Republicans) would run from this type of proposal because it removes the illusion that undisclosed parties—corporations, the top 1%, or government printing presses—would pay the freight. It would change the conversation from health care as an entitlement to health care as a transaction. Everyone would get basic coverage. Those who trust government to manage the process would get their wish, but they still must pay the tax. The rest of us can opt out and stay in the private system.