The offspring and I were on the phone today shaking our heads, from slightly different angles, about what the Republican presidential candidate considers healthcare reform. Her angle was that of a clinician in practice. Mine is that of a writer on healthcare.
Neither the man, nor the party, have a clue. I'm not certain the other side has a clue either, but they could hardly be more off base.
Over my working life, I've come in line for tax credits at various times and for various reasons. The child care tax credit is one I recall best. Speaking not as a tax lawyer, but a consumer, I can tell you that the tax credit is worth about ten cents on the dollar. For those who haven't noticed, the credit comes off your liability; it's not money handed back to you outright. The child care credits I once received, the energy credit I got last year, and a couple of others I forget gave me back perhaps one month out of a year's worth of expenses.
To put $5000 in every taxpayer's pocket, you wind up paying taxes to them, instead of the other way around. If you go that far, almost any alternative national health insurance programme would cost less and would deliver more care to more people. So far into delusion will ideology take a political candidate.
The Republican plan is also assuming the best health insurance risks--the young, prosperous and healthy--actually would buy health insurance with their ten cents on the dollar. When last I looked, these are the same people that Massachusetts has had to drag kicking and screaming into its universal coverage plan.
As my child points out, opting out looks like a great idea until it's you on the gurney. Five grand won't buy you a single night's emergency room care. Five hundred won't get you past the registration desk in a lot of ERs. She has seen young, once healthy and prosperous patients who will never be either again, who did opt out because nobody made them opt in. Most of them are looking at bills of over $1 million: that's 200 years of $5000 tax credits.
Tax credits don't fix the fundamentals of a broken system. Healthcare costs as much as it does partly because it is so big, so complex, and so laden with contradictory regulation that no one really knows how much it does cost. It would be nice to blame it all on Medicare, except that the private insurers are just as much part of the problem as the government. It's much like the old Thomas Nast cartoon
of the Tweed ring pointing fingers in a circle. Unlike the Tweed ring, this circle has many people in it who want to stop the madness.
The Republican plan differs from all others in being a great deal more naive. It's no more a plan than it would be first aid to stand next to a 20-car smashup handing out band-aids.