I am writing this for people like me, who when they
hear the words "health care" and "universal" in the same sentence,
immediately think "Hillary" and "socialized medicine."
"Socialized medicine" is when the government runs the health-care system
like it does everything else, and we all die soon. Think Big Dig. Think
inadequate equipment for a war, with the money spent on pork projects
that re-elect politicians, instead. Imagine leaky heart valves or the
100 brand-new Sen. Whoever clinics for some disease popular with movie
stars while emergency rooms fall apart.
Fortunately, Gov. Mitt Romney's new health-care plan isn't socialized
medicine. It isn't even the "universal health care" of former Gov.
Dukakis, funded by an employer mandate.
That Dukakis proposal is still floating around and will be part of the
discussion on health-care reform this year. The groups trying to place a
question on the ballot are the same ones who want taxpayer-funded health
care. But their language is interesting, a unique approach: It calls not
for universal health care, but universal health insurance.
When I saw it, I was somewhat impressed, since this is an honest
proposal. In the past, proponents would carry on about people with no
health care as if there were dying bodies all over the sidewalk in front
of our hospitals.
The truth is, everyone in Massachusetts gets health care. For those who
don't have insurance, it is paid for either by state and federally
funded Medicaid if you're poor or through what is called the "bad-debt,
free-care pool" if you simply don't have any insurance and can't afford
to pay out of pocket.
Let me just say here that the care ain't free. The total funding package
for the pool is complicated, and over the years has included surcharges
on paying patients, and payments from insurance companies and hospitals
into the pool. Wealthier hospitals subsidize others that serve poorer
Taxpayers pay directly for Medicaid and part of the pool. They pay
indirectly as well through higher health insurance premiums. So this is
the bottom line: We already have universal health coverage, and we
taxpayers, one way or another, are paying for it.
Points are also made about efficiency since patients without insurance,
instead of visiting their doctor for ongoing wellness, visit the
emergency rooms when something is wrong with them, even if it's not an
emergency. It's much more expensive this way, but it's not costing the
uninsured patient anything anyhow; so why should he care?
While most of the uninsured are poor, many are young people who feel
invincible, so they would rather spend their money on something more
immediate. I paid premiums for my son between college and his first real
job (defined by me as having benefits). I felt I had to take
responsibility for my family as well as myself. He'd rather have had a
The unemployed can stay insured, but must pay very high premiums as
individuals. I've never understood why they can't get together and
create an unemployed health-care group. Why can't there be neighborhood
health-care groups, or reading club groups, or cat lover groups? But
usually, even small businesses aren't allowed to group together to
negotiate rates with insurance companies.
Gov. Romney's new bill, a promised early proposal in the coming
statewide debate, mandates insurance. More of the very poor are
identified and moved into Medicaid; new, more affordable insurance
packages are created for small businesses to offer their employees; and
employees and other people must get themselves insured. If someone has
adequate savings to pay for health care, they can opt out — but there
can't be many people around who can afford to cover the cost of a major
hospitalization by themselves.
If they can't, yet refuse to get insured, they will become ineligible
for the state's personal exemption from the state income tax, and
possibly have their refunds kept or their wages garnished. The state
will keep the money from this exemption as at least partial payment for
the "free" care.
The governor's proposal will be studied, criticized and adjusted as the
meetings begin on health-care reform.
Libertarians who do not believe in anyone subsidizing someone else will
continue to object. Liberals will be looking for ever bigger and more
expensive starter insurance policies. Some will be offended by Romney's
use of the phrase "personal responsibility" to describe what his plan is
all about. They prefer the "community" concept, roughly stated as from
each according to his ability to pay to each according to his need.
But personal responsibility is the best part, and should be included in
all government issue discussions. In this instance, it means that those
of us who must pay our own high premiums, either as individuals or
businesses, won't be totally taken advantage of as others get their
health care for free. The young who don't think about it at all, and
others who know they will get taxpayer subsidies if they need them, will
have to contribute at some level.
It looks like a good start toward health-care reform to me.
Barbara Anderson is executive director of Citizens for Limited Taxation. Her syndicated columns appear weekly in the Salem
News, Newburyport Times, Gloucester Times, (Lawrence) Eagle-Tribune, and Lowell Sun; bi-weekly in the Tinytown Gazette; and occasionally in the Providence
Journal and other newspapers.