Prospects rising for better health care delivery
By Bill Roy
Topeka Capital-Journal
Dec. 20, 2008
As December began, President-elect Barack Obama invited our nation’s governors to meet with him in Philadelphia. I am told 48 governors showed up on 48 hours notice to discuss with him state budget problems.
The good news was Obama indicated some of the promised stimulus package will be channeled through the states to help them fund basic services, most particularly education and health, which claim well over half of every state budget.
That meeting was good for Obama, good for our states and good for our governors, who want to provide the best educational and health care services they can.
America is a great nation. Much of its reputation for good government is derived from good state governments.
In my most fertile imagination, about March 1, President Obama and new secretary of Health and Human Services, Tom Daschle, would call the governors to whatever site they choose and tell them they have a plan to turn health care administration and delivery over to them, along with adequate funds to implement the best system they possibly can.
Daschle could say, “The principles of this plan are so simple that we believe that after careful study you will quickly call upon your members of Congress to go to work and pass the enabling legislation.”
When I was a once-upon-a-time congressman, unprejudiced by previous public service, I realized, and repeatedly stated in Washington and on the stump, that if we didn’t have states we would have to discover them.
State governments are both physically and culturally closest to the people they serve. If people of a state don’t get decent government, it’s usually their own darn fault. States also differ greatly in a multitude of ways, enough so to nearly always guarantee one federal law or one federal program does not fit all.
Many eager states have had a lot of sad experiences trying to have universal health care for their citizens and trying to pay for it. Without exception, they have failed. Oh, they have done some good things, such as marginally decrease the number of uninsured, provide public hospitals and support education and training of health professionals. But they have always fallen short on coverage and money.
But with this proposal, the federal government will share costs if states meet a handful of requirements. Yes, other countries have been successful with similar programs, although admittedly all nations are having difficulty keeping up financially with the rapid advance of biomedical sciences. But the other 29 nation-members of the Organization for Economic Cooperation and Development have been successful in covering nearly everyone for about two-thirds of what we are spending. Our problem isn’t money, it’s trying to deliver care through scores of money-making private health insurance companies.
This country has talked about universal health care too long for anyone to try to be cute, so I won’t. Yes, these are Canadian principles, and it could be called a Canadian plan — and that water was poisoned long ago. If it needs a foreign name, it might be best to call it the Taiwan plan, because that nation implemented a similar single-payer program in 1995 after studying the health systems of industrial nations to find out what works.
The Taiwanese have a smart card that includes all medical information of the holder, and is used for automatic billing that reduced their administrative costs to 2 percent, about one-tenth of our average administrative costs.
The requirements for states to receive federal money would be straight-forward: universality, comprehensiveness, accessibility, portability, and public administration. Yes, it could also be called state-administered Medicare for All.
The privilege of buying private health insurance to cover uncovered services or amenities distinguishes this proposal from the Canadian system, which absolutely forbids private insurance. It makes the system less egalitarian, but infinitely less discriminatory than our current system where health depends on income.
Bill Roy is a retired physician and former member of Congress. He has a law degree and lives in Topeka. He may be reached at wirroy@aol.com.