and the
Citizens Economic Research Foundation

Barbara's Column
June #5

It's about time:
Romney health plan touts personal responsibility
by Barbara Anderson

The Salem News
Friday, June 24, 2005

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 populations.

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 new car.

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.