In 2015, total spending on healthcare in the United States was $3.2 trillion – $9,990 per person – representing $1 out of every $6 that anybody spent on anything. The federal government coughed up 29 percent of that amount, $2,897 per person, according to the federal government website Centers for Medicare & Medicaid Services.
When guns-n-Bibles patriots advocate for dismantling Obamacare and federal healthcare entitlements, they claim it’s because we can’t afford it; and because mandating the purchase of health insurance is tyrannical and un-American; and because they don’t want to pay for the healthcare of undeserving people.
On the other side, liberal do-gooders claim it’s heartless to let people die just because they run out of money; and besides the cost of an increasingly unhealthy populace would create more economic damage over time than helping now to pay for their diabetes medication.
I think both arguments are unnecessary because we can give both sides what they want through a federal healthcare opt-out.
Here’s how it would work:
Expand Medicare and Medicaid into a true single-payer system for healthcare, which would cover every American from birth for all medical care (we’d have to talk about whether boner treatments for men and boob jobs for women are included; I can see both sides of that debate, and don’t want to get bogged down here in wonkish policy details).
All of this would be paid for through taxes, and designed to push down the cost of healthcare the way it’s done in other Western democracies.
But people who don’t want to pay the tremendous cost of this system wouldn’t have to. They would be allowed to opt out of it at any time – immediately receiving an annual tax credit for their share of the healthcare bill – whatever that amount is calculated to be on a per-person basis. That’s it: No mandate, and no chance that your tax dollars are being used to help someone whose religion, race or sexual identity is an abomination to you.
But wait, there’s more. While the current regulatory philosophy would continue to govern the federal single-payer system, there’s no such need to impose it on the private markets, now that we’ve given people a choice. So we can also give healthcare executives what they want: Deregulation. Let’s remove the handcuffs that hold back insurance companies, pharmaceutical makers, device manufacturers and giant hospital corporations from improving our healthcare outcomes. Just as it did with airline companies and air travel, this would most certainly usher in a golden age of innovation in healthcare.
I can see it now. Pray Away the Pain policies starting at just $99 a month for the entire family. Surcharges for wasteful single-use syringes and IV bags. First-class surgery suites where a white-gloved black person (or a Mexican – or for the really wealthy, an Asian med student) holds the urine sample cup while you fill it. For the cost-conscious, DIY home colonoscopies, with results reviewed by a guy with an authentic Indian accent who calls himself Doc while working the night shift in Mumbai.
Finally, insurers could bring back important profit enhancements, like exclusions for preexisting conditions and anything involving a uteris. Of course, many people allegedly don’t like these exclusions, but with enough advertising and some well-designed loyalty programs (buy 6 dialyses and your 7th is free) it’s been proven that you can get people to buy just about anything.
“Opt-Outs” (as we’ll call them) could acquire their services from any source – from platinum to bare bones and anywhere in between. Their choices would be unlimited, with offerings sure to please everybody, from God-fearing varmint-hunting mountain dwellers to deal-making urbane real estate moguls in penthouse aeries.
If this unfettered capitalism goes as well as some expect, you might think people in the dull old federally subsidized system would get jealous. But that’s not a problem either. Staying in the single-payer system doesn’t mean you can’t spend your own money to buy extra care elsewhere. And you can opt out any time you want. Now that’s what I call freedom.
But here’s the catch – and how the whole thing can be economically feasible without that pesky insurance mandate: It only works one way. You can stay in the single-payer system and acquire extra care through the private system. But when you decide to opt out of the single-payer system, you can only acquire care through the private system. And the decision to opt out is final. For the rest of your life. You can’t get back in. Ever. Even if it means you die because you failed to read the fine print the last time your policy renewed.
To some, this will sound mean, but it’s actually very humane. Let’s face it: Everybody is going to die eventually; this just gives people a chance to decide if it’s their time, or whether that decision is best left in the hands of a for-profit insurance company.
I’ve never met anybody who is wishy-washy when stating that the private sector can do anything better and cheaper than the government. So for the people most likely to opt out, this isn’t even a gamble. It’s a sure bet. (Maybe we include a 3-day window or something in case they get buyer’s remorse, like with a used car. That’s another detail we can work out.)
Lose a leg in an industrial accident? You’re going to spend your own money on a prosthetic limb or hop around for the rest of your life. Cancer? If you want to live badly enough, you’ll come up with the money. Eat some tainted baba ganouj? Grab a barf bag, because you chose not to pay for other people’s healthcare, and they don’t pay for yours.
It’s the best of both worlds – a single-payer system that guarantees terrorist-loving tree huggers won’t go bankrupt just because they get sick; and a private-sector system that gives liberty-loving capitalists whatever choices they’re willing to pay for. Both existing side by side in perfect harmony. Like ebony and ivory. Tomatoes and tomahtoes. Mason and Dixon. Everybody’s happy.
I don’t see this as actually creating two separate healthcare systems. The same providers will probably choose to serve both – though if forced to decide, I suspect there would be plenty of providers who choose to serve the government system rather than take orders from insurance companies. As for those insurers, they’ll figure out a way to make big money selling private health insurance policies while making honest money managing the government system’s bookkeeping.
What about children? Well, parents who feel strongly against a health insurance mandate, whether for political, religious or mental-health reasons, would have to be allowed to opt them out too. After all, a parent can choose whether to give the child a real education or a fake one, and whether to spank or coddle. Why shouldn’t parents also be able to choose whether or not their child will receive healthcare through the government or the private sector?
Yes, many cute, innocent children may die as a result of this. But that’s the price of freedom. They will be heroes. Maybe we’ll create a monument for them in Washington, where bereaved parents can go to trace etchings of their names. Anyway, it’s only temporary. Because at some point, children usually grow up and start making their own life decisions, and my plan allows for that too.
There would be a big moment in the life of every surviving “Opt-Out Baby” when they get to decide if they want to be part of the social compact after all – a one-time window when they come of age and can choose to rejoin the single payer system, for better and worse. Maybe it’s when they turn 18 or emancipate themselves in order to enroll at a school that teaches evolution – whichever comes first. Maybe the window is 30 days, maybe it’s a year. Those are more details we’ll have to hammer out in committee. But the point is that there is a moment when children are called on to put their own value system to the test and exercise their own judgment – true Americans deciding which version of freedom means most to them.
I can hear the critics already saying the federal system will collapse under its own weight as anybody with money leaps to opt out and buy their healthcare from the for-profit marketplace.
If that’s what happens, so be it. At least it would happen because people got to make their own choice – which is what our elected leaders are always fretting over.
I can hear critics from the other side too, saying only billionaires would be crazy enough to opt out of a single payer system and take their chances with the greedy profiteers of the private sector. If that happens, I won’t be surprised. And companies serving the private market will face the thing they claim to cherish most: real competition in the marketplace of ideas.