Let's Create a National Emergency-Health Plan

Lawrence O'Donnell may have ripped the scab off an ugly sore on the body politic (MSNBC's Hardball on August 14). O'Donnell's opening gambit was to ask Rep John Culberson (R-Texas) whether he would vote to repeal social security given the chance. Culberson didn't give a direct answer, so O'Donnell then asked him whether he would have voted against Social Security in 1935 and Medicare in 1965. Culberson said he would have voted for Social Security but held out for some time before finally claiming he would have voted for Medicare as well. O'Donnell then bluntly accused Culberson of lying to the American people about the “evil of government health care.” It seems more likely to me that Culberson would not have voted for Medicare because conservatives evidently care more about limiting government spending and taxes. Their apparent indifference to the plight of less-fortunate Americans is selfish but still within their rights. What is getting ugly, though, is some conservatives' attempt to frighten voters, for example with talk of “death panels.” I think conservatives should examine their consciences and back off from such activities bordering on hate-mongering, which is a great crime.

Having a pessimistic view on the practices of insurance companies myself, I find it difficult to fault healthy people who don't bother with insurance. However, such people are not entirely self insured because they are eligible for free emergency room care at hospitals that accept Medicare patients. This under-funded work load is probably degrading the level of care hospitals are able to provide, even to patients who believe they have adequate insurance. By the way, it is remarkable that the uninsured are not the ones pushing for reforms. If the uninsured are relatively satisfied, what does that say about the benefits of private health-care insurance in America?

I think the uninsured are getting too good a deal from the American health-care system. They should pay their fair share into what might be called a national emergency-health plan or NEHP for short. To make sure they do, the plan could be funded by an employment tax like those currently collected for Social Security and Medicare. I would be willing to pay such a tax because I would feel better about my chances in more adequately-funded emergency rooms. It should reduce the cost of my other coverage, too.

The primary purposes of NEHP should be to maintain the availability and quality of emergency room care for anyone who's health might be endangered and to provide a safety net for the uninsured. Admittedly, the services performed for the uninsured under NEHP would be rationed in the sense that a trip to the emergency room could result in a long wait if the staff is busy with other patients whose immediate need is greater. I hope conservatives can agree that such rationing would be justified. NEHP might even evolve into rationed socialized medicine as the cost of private insurance continue to rise. But if it does, it will be because private insurance has failed to provide an affordable alternative to the dreaded rationing of socialized medicine.

Finally, I think it is worth observing that opportunities often come disguised as problems. And the US economy has reached a turning point because the rest of the world can now manufacture enough affordable and very good television sets and cars and computers. Medical science and technology also seems ready to start bending the lifespan curve upwards again. For example, personal genome maps are likely to become affordable in the next few years and probably will provide excellent new options for preventative care. I think the rest of the world would appreciate America taking the lead in finding the fountain of (extended) middle age!

(first posted August 26, 2009

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Copyright 2009, Terence J. Nelson