Now that President Bush has signed the $400 billion Medicare bill, there's plenty of time before most of the senior drug benefit kicks in -- in 2006 -- for us to kick back and think bigger thoughts.
Here's a thought: Why not join the rest of the world's grown-up nations and provide health care for everyone, not just seniors. Expand Medicare into a universal system to take in all citizens, not just the elderly and disabled.
That's socialized medicine! some will say. Free health care for all, cradle to grave? Paid by the hated government? You can't be serious!
I am serious, and I'm far from the first to mention the idea. Some presidential candidates see the lunacy of America's wasteful, complex patchwork system and advocate a "single-payer" plan. Universal health care, or something close to it, is as normal as fingernails in Britain, Canada, France, Germany and elsewhere. We've been in the industrialized world's backwaters long enough. Universal publicly financed health care would be socialism! objectors will say. We don't want the government in our medicine cabinet!
But let's look at socialism. The country's already rife with it. We have free public education. That's socialism. It means government -- that is, the people -- have decided education is so important for the nation's well-being that every kid ought to have it. Is good health care less important?
We have socialized streets and highways. They're necessary for commerce, defense, recreation, even Christmas travel. Government in several forms -- municipal, county, state and federal -- create socialized thoroughfares.
We have socialized libraries because books are important to any civilization. We can borrow socialized books for the asking.
We have socialized police, firefighters, air traffic controllers, meat inspectors, border patrols, national parks, the military, space exploration, veterans' services, workplace safety watchdogs. The list goes on.
There simply are some things -- not all, by any means -- that we've decided government does best. Under our Constitution, "we the people" are required to do things for the common good. And that those things are done through something called government.
Some people hate government. Right-wing extremists call it a beast and try to starve it. Influential forces in the Bush administration apparently agree. But the beast is being fed, not starved, on the installment plan. We've rolled up a deficit of nearly $375 billion and a national debt of $7 trillion. As things now stand our children and grandchildren will pay dearly. Surely, with all the pork and out-of-whack priorities, there's room for universal health care.
But for now we have Bush's Medicare revision, most of which doesn't start until 2006. (An earlier change comes in about June, when seniors can buy prescription discount cards that Bush says will save them 10 to 25 percent. Experts say the lower figure will be closer to reality.)
In 2006 patients will pay a $35 monthly premium and a yearly deductible of $250. This will cover 75 percent of the cost of drugs, up to $2,250 a year. (Thus a sizable chunk will come from the patient.) Then comes the "doughnut hole." Above the $2,250, Medicare pays nothing until the patient has forked over $3,600 out of pocket. At that point Medicare pays 95 percent.
The New York Times says a person with $5,000 in yearly drug expenses at current prices will pay 70 percent of the cost.
Among Americans of all ages, 43 million now have no health coverage. But with a universal single-payer system, low-income people no longer would have to resort to high-cost emergency rooms for nonemergency treatment financed by the rest of us. We would minimize the time and waste of computer-punching and paper-rattling created by a dizzying maze of providers, each with complex and conflicting requirements and benefits. Think of the effort and expense each doctor's office is saddled with because of this mess.
Think how universal medical care would improve American lives by scraping away much of this clutter. Costs to patients would be little or nothing, although taxes would have to rise. But the net effect could be healthier, happier people -- some of them no longer forced to choose between skipping doctor visits and skipping meals. Americans living with better health care, free from worry about its cost and complexity, could be more creative, more productive. By combining single-payer universal care with our acknowledged high-tech superiority, we could validate our claim to the best health care system in the world.
Sam Newlund is a freelance writer and retired Star Tribune reporter.
© Copyright 2003 Star Tribune