Ipsism Cerebri*

Ipsism has withheld comment for almost six months to allow Mr. Obama the opportunity to enact the 'change we can believe in' with his 'audacity of hope'.

Now, all that the Obama Administration can say is 'we misjudged' on every facet that they claimed expertise while campaigning and during the first 100 days of his administration. Generally, Ipsism does not believe that it is correct to simply say 'you're wrong' without giving an explanation or alternate model to be evaluated. Ipsism does not believe that the Obama Administration is working from a concept of reality. Obama continues to play his self admitted blank slate while allowing people to believe that they are going to get what they want.

First, we need to look at the reality of the healthcare system which composes one-fifth of our economy.

Mr. Obama has said that all spending is stimulus. Then, why is spending on health care not a good thing? Certainly, health care is not a black hole that sucks money out of our economy. Is building a hospital or clinic not construction spending? Does the billions of dollars that General Electric profits on medical equipment not spend or pay their shareholders equally as well as profit from wind mill turbines? Are the jobs and wages of millions of physicians, nurses, technicians, bookkeepers and managers in healthcare not as honorable as in any other field? Do these people not buy groceries, clothes, homes and automobiles like other workers? Is the service they provide not seen as the best in the world?

So what does Mr.Obama wish to 'change'? Not the tort system, he's said he won't support change in tort reform. Not access, everyone in the United States has access to emergency medical care by Federal law. The only thing that Mr. Obama wants to change is who pays for the healthcare. Mr. Obama wants a governmental bureaucrat to determine the scope and extent of the health care that every individual is permitted to receive. And, the decisions will be made as to what is in the best interest of the government, not the individual.

Let's look at some of the reality of healthcare.

1) There is a never ending desire for healthcare. Almost everyone expresses a desire that 'everything' be done when they or their loved one is in need of care. It's only during a period of recovery or mourning that they lament the cost that was incurred in doing 'everything'.

2) No one, not even the United States Government can pay for 'everything' that 'everybody' wants. Mr. Obama has admitted this. His bureaucrats will determine whether a person should just be given pain pills or corrective surgery. Yes, that's exactly what Mr. Obama said.

3) Healthcare, of necessity WILL be rationed. Currently, under free market capitalism, it is determined by an individual's ability to select and pay for their own healthcare. Mr. Obama wants a government bureaucrat to determine the rations. Some advocate this as a form of reparations. If that is the intent, then the government will be creating a system just as evil and onerous as the one for which it purports to compensate. If this is the intent, by necessity, it will be denying care to groups on the basis of race. One need not argue the concept of two injustices not making for justice.

4) Some will argue that it's not 'fair' that the poor cannot currently pay for ALL the healthcare that they wish to consume. Where in the name of all that's holy did this bit of nonsense originate? Even Jesus said, "the poor will always be among you". Why does anyone have more of a right to healthcare than food? Shouldn't everyone be able to dine on caviar, tenderloin and truffles? Why do some people have to eat hamburger helper or beans and rice? Why shouldn't everyone have a Rolls Royce and a Ferrari instead of an old used Chevy? The argument is specious, intended to play to your sympathies. And, you better believe that the government bureaucrat is not going to be sympathetic as they use convoluted logic to deny care to you and your loved one under a Federal Healthcare program.

5) Every insurance program has an overhead expense. Typicality, private insurance companies anticipate a 25% overhead in its premiums. Government administrative cost is figured to be on the order of 42% to 45%. Obviously, for the same premium amount, you will receive less benefit from the government than a private insurer. And, if the government is going to save money, it's got to spend a LOT less on benefits. That means you're going to get a LOT less care, hence the need for strict rationing.

6) The only real complaint that anyone has with healthcare in the United States is cost. Mr. Obama wants to impose a stripped down, highly rationed system. Don't believe it? Look at what the politicians are exempting: themselves and unions. Employers are prohibited from utilizing the government healthcare plans for unions. Why? Union plans are far superior to what the rest of the country is going to have shoved down their throats. And what are the chances that a Federal Government healthcare system is going to be successful and cost effective? People talk about the Veterans Administration and the Post Office as examples of government inefficiency. A couple of years ago, Forbes Magazine stated that three-quarters of ALL Federal Government programs were inefficient and ineffective.

7) The United States healthcare system is overwhelmed by people who don't need to see physicians. Years ago, it was estimated that 80% of visits to primary care physicians were not medically necessary. The response was the rise of physician assistants and nurse practioners. This needless expenditure needs to be curtailed.

8) The statistics don't tell the story of healthcare. Most of the prolongation of life and increased longevity are due to antibiotics, not the glorified nutritional and lifestyle changes advocated by healthcare gurus or the cancer researchers who spend billions. The other area is in child birthing. The United States has an heterogeneous population. When similar groups or ethnicites are compared, the US ranks at the top in every category. Some groups and ethnicites impose an unhealthy life style upon themselves. As a consequence their healthcare outcomes are diminished compared to those that do not. Increased expenditure of resources is not going to overcome the self imposed risks of those ethnicites or groups.

9) the current healthcare system does nothing to encourage cost containment in a meaningful way. Employer sponsored healthcare plans that cover first dollar costs or have only a small copay encourage over-utilization. The myth of cost containment through preventative care or early detection do not reduce overall expenditure. Costs for individual treatment of a disease may be reduced but total healthcare cost is swamped by the total number of people receiving preventative care. Insurance plans without a benefits cap do nothing to discourage expenditure. Federal programs such as Medicare and Medicaid increase the overall cost of healthcare. Because Federal programs pay only a fraction of actual costs, prices to non-Federal patients are inflated to cover Federal beneficiaries. Similarly, overly generous plans such as negotiated by the unions encourage healthcare providers to inflate prices to capture as great a payment as possible. Additionally, union members and their families tend to over utilize healthcare. Should insurance really be paying for Viagra?

10) Pharmaceutical companies are making huge profits on the drugs that they sell. True, government regulations have the effect of imposing billions of dollars of development costs upon pharmaceutical companies. And, they deserve to make a profit. Federal regulations prohibit the importation of generics or foreign produced brand name drugs. But, part of the problem is the public. Pills are panacea. The public demands pills for a quick cure. Have a cold? Take some pills. No, they aren't going to make you get well sooner. But, you got a pill to justify going to the doctor. Chicken soup would have done just as well for only a buck.

While one can argue as to the need to include other realities, they usually resolve to emotional arguments that bear no relation to reality. Yes, it would be wonderful if there was no disease, no birth defect, no cancer or any of the other affliction which generate so much emotional appeal. But, all of the emotion will be lost in a government healthcare system. What will remain are political considerations. Will your cause promote the power and grasp of those in office?

So what is Ipsism's answer?

Ipsism would use the following concepts to guide policy.

Ipsism prefers that the individual be allowed to ration their own healthcare, NOT the Federal Government. If an individual wishes to spend nothing or everything on their own health care, they should have the right to do that. It's obvious that Senators Kennedy and Byrd are not being rationed in their healthcare as they would legislate upon you.

Healthcare consumers must be responsible for the spending of resources on their behalf.

All citizens SHOULD be treated EQUALLY in terms of taxation or deduction of healthcare insurance and benefits. No group or class should have legislated preference in healthcare, or taxation.

To accomplish reform, Ipsism would legislate:

Healthcare benefits and insurance would no longer be an employer deductible.
Healthcare insurance and expenditures would be deductible on personal income tax returns.

These will create even taxation for those currently receiving employer benefits and those who pay for healthcare themselves. Employers can increase wages to compensate.
Insurance companies would be required to have, as a minimum, a significant deductible. Let's just say ten percent of the poverty level.
Insurance companies could only reimburse payments to individuals and healthcare bills could not be subrogated to hospitals or providers.
This will force the consumer to be involved in pricing decisions and encourage competition between providers and hospitals.

States could not mandate specific benefits in a healthcare insurance policy. States could mandate specific coverage as an option for additional premium. Insurance companies could compete on all premiums.
Health insurance companies would be registered nationally and could sell policies across state lines. Core benefits would be standardized for competitive comparison.
Healthcare policies would have a defined benefit limit.

All healthcare insurers would be required to participate (proportional to their market share of healthcare insurance) in a high risk pool for catastrophic conditions and otherwise uninsurable individuals.

The decision to purchase healthcare insurance is up to the individual. But, just as with automobile insurance, if you don't have healthcare insurance, you can't have a driver's license. If one truly cannot pay for their own healthcare insurance, the Federal government may subsidize their participation in the high-risk pool

If an uninsured presents for healthcare, they must make arrangements for care or may be denied treatment. For those who argue that this is too hard hearted, Ipsism points out that it is more compassionate than you are going to receive with a Federally rationed system.

Obviously, this does not provide for every facet of an healthcare system. It does provide for a framework that places responsibility for healthcare on the individual, rather than further surrendering our lives to a Federal Bureaucracy.