August 9, 2017 10:44:14 AM
OXFORD -- There are certain certainties we accept: death and taxes. Other certainties can be deduced from trends. For instance, the sun will set on Mississippi's beleaguered state flag. Eventually there will be a new banner. Perhaps it will even be unifying. Another is that legalization of recreational marijuana will spread to all 50 states. Legislatures are increasingly flocking to this "pot" of gold.
Another certainty is that there will be universal, cradle-to-grave "free" health care across America.
It will happen.
The die has been cast.
Asa Hutchinson is the conservative Republican governor of Arkansas who made headlines earlier this year for pushing to execute five convicts back-to-back. He should be making more headlines for his acceptance that universal care is inevitable, and that the conversation should center on how best to make it work.
Hutchinson and legions of others truly understand the vast inefficiency of the federal government in managing services. The difference is he's dealing with his angst instead of denying the future.
The underpinning is this: America wasn't designed with efficiency in mind. At all levels, the blueprint called for maximizing individual liberty, which, by the way, is the core proposition of those who insist national health care is yet another something for nothing program.
To stick with that is to reject the positives of shared services.
Even before there was a federal government, Ben Franklin understood the mail (and commerce) would move better if there were public highways, state-to-state, that met up at common points. As postmaster, he ordained "post roads." The public shared in the costs. Some paid a lot. Some paid not a penny. Everybody benefited.
There are many, many other examples of shared services. Each has a funding mechanism; some have public-private ownership.
The biggie is the armed forces of the United States. Some pay nothing; some pay a lot. The same is true for public schools, state and local law enforcement agencies and even utilities. We don't all have to have our own wells, septic tanks and generators and we pay water, sewer and electricity bills based on our use.
Collectively, we support fire departments through taxes, and they respond without checking ability to pay.
Health care costs have had a pattern, too. Where Mississippi and other states at one time had public hospitals to provide "free" care with general fund revenue, the big picture now involves private insurance. But just like public programs, the core notion of the insurance industry has always been sharing the risk - albeit privately and profitably.
A car owner who never had a wreck helps pay the body shop after his neighbor hits a telephone pole. Mississippi requires car insurance, but no one calls it "socialized car repair." To dive a bit deeper, remember that Mississippi requires also motorists to purchase policies and "uninsured" coverage lest they collide with a driver who has no insurance.
One argument of those adamantly opposed to Obamacare or any federal insurance mandate is federal involvement will kill innovation. That's a real risk. The freedom the world of medicine has had to create better procedures, devices and medicines has no doubt been driven by the profit motive. Some say that would vanish. It would be crucial to retain an element of competition (as Obamacare attempts to do).
The first steps toward universal federal health care were taken more than 60 years ago when Congress created Medicaid for the poorest of the poor and disabled and Medicare for senior citizens, regardless of their ability to pay. Both have evolved into gnarly, marginally functional and highly wasteful systems that are breaking federal and state treasuries. Both require participants to pay, but coverage is provided whether payment is made or not.
Now consider this: More than 400,000 (14 percent) of Mississippi's 3 million residents are 65 or older and, although there is some overlap (dual eligible), another 675,000 (23 percent) are enrolled in Medicaid -- even without the expansion proposed by Obamacare.
See? A single-payer system is a certainty. There is no "going back to the old days."
Instead of fighting it and failing to recognize it is an evolutionary step in shared services, Hutchinson has a task force examining using state Medicaid dollars to purchase private policies. Maybe it will work; maybe not. In any event, it's better than just ignoring the situation, continuing to cut funds from other state functions to prop up Medicaid. It is pointless to hope the challenge of creating the best possible shared services system will go away.
Universal health care is coming to America. Deal with it.
Charlie Mitchell is a Mississippi journalist. Write to him at [email protected]
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