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Charlie Mitchell: Issue is not health care, but who pays for health care


Charlie Mitchell

Charlie Mitchell



Charlie Mitchell



OXFORD -- Fred has four children. As they head out to the bus stop each Monday morning, he gives each one $10 for snacks and incidentals. Question: How much cash must Fred have? 


The math is not difficult. 


And, in general terms, it illustrates how the payout side of health care in America could work. 


In other words, the total cost is predictable. 


The Kaiser Family Foundation reports that per capita health spending in Mississippi for 3 million people was $6,571 in 2009. 


So, if it was Fred's job to pay everybody's medical bills, he would need 3 million times $6,571 in his pocket every Jan. 1. That total -- roughly $20 billion -- would have covered it. No muss. No fuss. Done and done. 


Now open-ended entitlements do exist. The total needed for jobless benefits or food stamps depends on how many people are out of work and unable to support themselves. In a robust economy, these expenses shrink. In a bad economy, they grow. 


Health care isn't like that. Even though the sources for the money vary, the total needed can be calculated. And even though costs are rising at an obscene clip, the angle of increase is pretty much the same. (The Mississippi rate in 2009 was doubled the total 12 years earlier.) 


The Affordable Care Act represents a strong stride in the direction of a single-payer system. But for the foreseeable future, the costs of health care will continue to be covered by a combination of personal funds, private insurance funds, taxpayer funds and write-offs by medical groups for uncompensated care. 


"Complicated" doesn't even begin to describe the maze. 


Neither does "profiteering." 


Even calculating the per capital expenses was complex for the Kaiser Foundation -- the research and philanthropic arm of a company devoted to analyzing risks. 


The first difficulty was adding up all spending for public and privately funded personal health care services and products, which included hospitals, physicians, nursing homes, prescription medicines and such. Next was a decision to have the total not reflect preferred provider and other discounts and not include medical administration and research costs. 


Clearly, Kaiser wanted a realistic figure. 


Most Obamacare discussions have been about something else. 


The administration has tried to focus the spotlight on "availability" of health services, playing the pity card by showing people bankrupted by medical expenses. Availability is an issue. About 15 percent of Americans are not enrolled in any public or private health insurance plan. 


But the vastly larger consideration is who will pay -- both the total and how the total would be apportioned. 


We were told Obamacare would pay for itself, would result in "savings." 


But it won't. 


For the poor -- those who simply cannot pay -- Medicaid has been available in Mississippi and nationwide for nearly 50 years. 


For the next tiers -- the "working poor" and the "middle class" -- there have been some public and some private options if employer group plans were not offered. But before Obamacare became law, there was no requirement that people obtain health insurance. There is now, and the U.S. Supreme Court has clearly declared it to be a tax, even though Congress refused to call it that. 


Many cooks -- too many cooks -- got into the action in drafting this law. The legislation requires coverages in all policies -- mental health, drug addiction services -- that were optional before, assures private insurance companies will make money and much, much more. Every stakeholder won protectionist provisions. 


Since the roll-out, a lot of attention has been focused on the nonfunctioning website. Some attention has been focused on "sticker shock;" some has been on the president's repeated pledge that people who liked their coverage would be left alone. 


But long term, the central challenge with Obamacare is going to be the same as it has been with the IRS code. From the years when almost everybody paid into the pool, the political imperative to make the "rich" pay more and the "poor" pay less had led to half of the adult population paying nothing these days. 


Obamacare doesn't even start out like Fred, with money in his pockets to pay what's due. 


An honest system -- one that collected what's needed to pay medical costs by ability to pay and, in turn, fund health care -- was a bridge too far. 


And the result -- unless the legislation is improved -- is that along with anything else our children and grandchildren may inherit, they will also be getting our medical bills.



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