The right to healthcare is a complicated subject. Many people agree that we should have a right to medical care. However, the various opinions of how to accomplish that often lead to squabbling and fighting over the details, so that the consensus is lost. In all of my research, I have not once found a comprehensive plan for adopting a right to healthcare. The subject brings up so many other questions such as the rights of businesses, and how we should enforce it. And how would we distribute healthcare to everyone? And the most argued question is, how will we pay for it - and why should one person be taxed to pay for someone else’s health care?
I think we should start with the simplest question, which is why we should have a right to healthcare. Some argue that there is no need to create such a right. However, the groundwork for the right to healthcare already exists within our legal structure. For example, federal law already forbids hospitals that have beds available from turning away any patient based on their ability to pay. Likewise, hospitals cannot discriminate against patients based on the type of insurance they have, such as Medicaid or Medicare.
Millions of Americans are already covered by an inter-cooperative system of government-backed healthcare programs. Medicare, the nation’s oldest public healthcare system, protects the health of an estimated 58 million people. Medicaid now covers 80 million Americans, with 10 million new insureds having signed up in 2021 alone. The Children’s Health Insurance Program (CHIP), which is part of Medicaid, provides health coverage for about 9 million of our minor citizens. And the hospitals and clinics of the Veterans Administration are available to approximately 18 million people who served in the U.S. armed forces. Taken together, these programs provide medical coverage to 165 million Americans, very nearly half of our country’s population of 331 million.
Clearly, we have been edging toward a government-sponsored national healthcare system for decades now. By taking the next step – recognizing that all Americans have a natural human right to receive high quality, affordable medical treatment – we can replace the heartless cry of “Why should we do that?” with a new question, “How can we make such a system work?
On this more progressive platform, we can address lingering questions about expanding public coverage for dental treatment and mental health care. We also can resolve inequalities among the public options, where dentistry is available to veterans and active service members, but usually not to those insured by Medicare and Medicaid.
There will still be plenty of resistance, though, even with the creation of a universal right to healthcare. That’s because many existing structures are making money just by keeping things the way they are. Our byzantine collection of agencies, bureaus, offices and administrations at the federal level will guarantee stubborn opposition to streamlining healthcare delivery if it means their administrative budgets may be cut. Some state governments will recoil when they are no longer permitted to divert public health money to local projects and institutions that have little to do with providing people with medical care. And the One Percent will balk when their carrot-and-stick offers of private health insurance becomes irrelevant, depriving them of one of their most important tools for keeping employees harnessed to high-stress jobs that barely pay enough to live on.
For example, let’s take a look at how states manipulate programs like Medicaid and CHIP, which are mostly funded by the federal government. Washington gives big blocks of money to states to fund and manage their in-state healthcare. This system actually was made obsolete with the creation of federal insurance exchanges under Obamacare, but it continues because there’s money to be had. States like Texas manipulate the qualifications for Medicaid and CHIP benefits to bar as many applicants as possible, then use the money saved to fund the operating budgets of state silos that can somehow be tied to the federal programs. The states thus create a revenue source with few strings attached, and those whose jobs are based on that revenue don’t want to give up their cushy jobs and their political power.
Similar fiscal mayhem occurs within Medicare and the VA medical system. Medicare empowers the federal government to issue health insurance to a large segment of the general population – so why not extend that power to issue health insurance to everyone who qualifies for Medicaid? (Information on who is qualified is readily available to the feds through income tax records.) But the idea repels members of Congress who want to keep federal funds flowing to their states and so enhance their electability, which is more important to them than any benefit that would go to their constituents.
For its part, the VA helps attract money and people into the armed forces. With a promise of lifetime healthcare during and after active military service, poor and working-class people can be seduced into becoming cannon fodder for “rich men’s wars” to gain power and resources. A coordinated and easily accessible national healthcare system would deprive the military of this lure, making disadvantaged young people less willing to become government property for use in increasing the power and resources of elected officials and the One Percent.
By the way, all three of the examples above can be explained succinctly by a sociopolitical aphorism known as Dan’s Rule: “If something doesn’t make sense but never changes, it’s because someone is making money from the status quo.”
So how do we get to universal, affordable and effective national healthcare, and what changes do we make? Here’s a plan:
1. Existing systems and programs to make a national right to healthcare not only legally possible, but actually functional. First, we amend the law to merge Medicaid, CHIP and Medicare into one program. Under this arrangement, Medicare qualification would be based on your retirement age, while Medicaid availability would be based on your tax filings for the previous year. If you qualify for either program, the federal government would issue you health insurance without your even needing to sign up for it. However, you would be free to decline federal health insurance and purchase private coverage instead. This changeover could be done under a matching pair of bills in the House and Senate. Medicaid would move into the Social Security Administration, and all tax dollars formally allocated to Medicaid would be moved into the revised Social Security structure. I propose calling this consolidated organization the United States Healthcare System. This name change is important because it will save federal money for managing and producing documents and collateral. Plus, few if any difference between the former Medicare and Medicaid systems (other than the qualification requirements) will make different names unnecessary.
2. We must amend federal law to forbid the federal government from borrowing Social Security money for any other purpose, such as funding the national debt. Once money is paid into the Social Security system it stays there with the funds allocated to the reorganized Medicaid system.
3. Expand Medicare so that supplemental third-party health insurance is no longer needed. This change would provide Medicare recipients with the same level of coverage that is currently available from Medicaid. This change will require an increase in Social Security taxes to cover the additional costs. However, I believe most people currently on Medicaid will gladly pay higher Social Security taxes during their working years to ensure good health insurance in their retirement, rather than the mediocre coverage now provided.
4. Make this health insurance system available to any person who would like to enroll and pay through the Obamacare insurance exchange platform. With this change, the subsidies paid out to private health insurance companies to lower the cost of health insurance would no longer be necessary, and would save the government lots of money while bringing down the actual cost of healthcare for these individuals. Under the current system, the health insurance exchanges artificially jacked up their service rates to get more profits from the government subsidies. It is a racket that makes healthcare reform most costly, because each time a health insurance company raises its rates, other health insurance companies follow suit, drawing more federal dollars out of the system and getting us less healthcare per dollar spent. This proposed law change creates a single-payer system as an expansion of what used to be Medicaid and Medicare and will now be the U.S. Healthcare System. Workers would pay for their health insurance through a withholding tax like that used to fund Social Security. This way, we do not need to maintain different billing systems and separate legal structures for collecting healthcare and retirement insurance payments..
We will enlarge upon the above with the following additional proposals.
1. Expand the US healthcare system to include mental healthcare and full dental care. This expansion of services will mean higher Social Security taxes for every working person and their employer, because government would be covering something that it has not offered before. However, I feel taxpayers would be willing to pay more money for this level of coverage, because health insurance that includes mental health and complete dental care is effectively a “Cadillac plan” traditionally available only to middle class and higher income earners. New coverage for dental health will save far more money in the long run, because timely tooth care prevents serious health problems that are much more expensive to treat. Also, it would end the practice of impoverished people getting last-ditch dental treatment in hospital emergency rooms, the cost of which indigents cannot pay and which ultimately is borne by the hospitals or the public. Similarly, guaranteed mental health treatment likely would help diminish school shootings, random killings and other destructive behaviors. Such behaviors can be equated to internal war within our society, so that affordable mental health treatment can be viewed as an investment in national security.
2. Merge Veterans Administration (VA) health services for military veterans and retirees with the new US healthcare system. This change would also include eliminating co-pays for all health care for anyone in the U.S. healthcare system. This action will ensure that insurance is no longer a racket where those who cannot afford the co-pays can’t get the healthcare they need. It also balances the care provided for non-VA patients compared to veterans. This change to the law also would allow veterans to see doctors and healthcare providers unaffiliated with the VA, in addition to preserving their VA access. With this change, the federal government would be able to redirect funds normally put into the VA system toward the Social Security Administration, which would include the US Healthcare System. If veterans choose to continue going to VA hospitals, the appropriate funds would continue to flow to the VA medical system. Thus, the choice of VA or civilian healthcare would belong to the veteran, and not the armed forces.
3. The next bill would allow currently serving members of the armed forces to choose going to private medical providers in the US Healthcare System while stationed in the United States. All armed forces health insurance would be issued by the Social Security Administration (SSA) and its medical branch, the US Healthcare System. At this point all military funding for healthcare would be allocated to SSA, except for the operations costs of military hospitals and other military medical facilities. These operational funds would still be issued to and controlled by the armed forces.
4. This brings us to our capstone bill, one that states directly that all persons residing in the United States legally shall be entitled a guaranteed protectable right to healthcare, and that no person or government agency shall restrict or deny healthcare, including mental health and dental care. Every person shall have the right to make their own healthcare choices unless they are deemed mentally incompetent, in which case the choice would be made by their next of kin or legal guardian. Also, the government would not have the right to force someone to use public health insurance. Individuals would retain the right to purchase and use third-party health insurance. Furthermore, the government would not have the right to prevent health providers that accept public health insurance from accepting independent third-party, nongovernmental health insurance.
In carrying out this federal legislative program, it is important that we change the legal system around health insurance and healthcare one step at a time. We learned with Obamacare that radically changing the system all at once creates unnecessary costs. Therefore these changes should be made in this order presented above, so that government agencies and businesses can make and implement change on a scale that is actually manageable.
From a management point of view, the first several years of Obamacare were a disaster. And yes, healthcare leaders have gotten it together and have ironed out a lot of problems with the management and execution of Obamacare. But we do not have to make the same mistake. I honestly think it would be a huge blunder to group all of these proposed laws into one bill and adopt them all at the same time. Attempting to do so will create unnecessary political and social pushback against making any change at all. Society is much more willing to accept smaller, sequential changes over time then huge changes all at once. Also, by making these changes over time decreases the cost to business owners who must also grow with these changes, and implement those growth strategies of the health insurance benefit systems these companies offer and maintain.
So here we have a step-by-step, realistic plan to bring the country to the point of being able to offer a guaranteed protectable right to healthcare. We cannot get there overnight and we cannot make all the necessary changes at once in order to guarantee a right to healthcare. Of course, the individual bills that are proposed in this paper would be far more substantive and detailed, but each bill must be developed not only by members of the various political parties, but also by consulting businesses and insurance companies to preempt as many problems as possible.
That said, we should all expect that the private insurance market will fight this program stubbornly until it is done. Because for them it’s about money and power, and they do not care how many people suffer or die from health conditions that can be treated or prevented. Insurance companies see you as a disposable resource to be discarded when your ability to provide them with money and power goes away. These companies would rather see unnecessary suffering and death than lose their little kingdoms of power. So we as a society must be willing to fight them, must be willing to do what’s right for the good of our country and the good of humanity.
These laws will help us become a society that values the quality of life of our citizens – and happy, secure citizens do not strike out against the government in the ways we are seeing now. If our government cares about national security, then it should also care about bringing guaranteed healthcare to the people who live here. History teaches us that a government that discards its people and does not consider their quality of life will eventually crumble, fall and die. Creating a protectable right to healthcare is a critical step in preserving our national security – and more than that, it is the moral and humanitarian thing to do. © By Josiah James Ingalls Cedar Creek, TX November 21, 2022