A casual comment from a schoolteacher friend brought to mind the current debate over national health care. We have a national health care system already, called Medicare, but it's age-limited, and those much less venerable than Venerable Mom aren't eligible. Proponents of national health care point to the success of Medicare; opponents complain about the cost and the spectre of creeping socialism.
My friend's comment made me think of an unsophisticated test for a national health care program: lets compare it to the public schools. We could (well, I can) imagine health care provided as the schools provide it, and then imagine education provided as we now provide health care. So here goes.
First, let's suppose that we could provide health care in more or less the way that we provide public education. Everyone would pay taxes to the local health care district in which they reside. The health care district would also get some state and national funding in exchange for undertaking the obligation to provide free (or very low cost) and appropriate health care for all of its residents who need medical attention. Each district would build and staff a number of health care clinics almost adequate to serve its population. People would register with the health clinic in their district. Some means would be worked out to allow clinics to exchange patients, or to cosponsor surgical hospitals (rather like the old union high school districts) so that not every district would need to provide a full range of care. The physicians would be somewhat underpaid, but in exchange would have tenure and a first-rate retirement program, won for them by their unions. All in all, not a bad system.
Now let's pretend that our government could provide education the way that it provides health care. People employed by large and generous corporations would be able to send their children to schools paid for by tax-deductible education premiums. People who lost their jobs could continue to send their children to school for another 18 months, but would have to pay the cost themselves, at just the time when they wouldn't be able to afford to do so. Private school insurance would be available, but inordinately expensive unless purchased in groups. Parents of slow learners who could not get into a group plan would find themselves slowly priced out of the market, or faced with notices of nonrenewal after Little Johnny fails a spelling test.
Students who want to study math or a foreign language would first need to obtain a referral from their primary care teacher, who could deny the referral if the teacher thought that the student wouldn't benefit from being able to multiply and divide, or being able to speak with the other 94% of the world.
People with no school insurance whose children, in an emergency, needed to learn the names of the states could take them to the emergency classrooms at the local schools. The schools would bill them for the education, but take few practical steps to collect, and ultimately pass the costs of providing emergency education onto their premium-paying members.
Some insurers would cover most of the schools in the area, but others would be selective, and parents who wanted their children to stay in the neighborhood school would have to pay up or change schools if Blue Cross or Aetna dropped their local school from its plan.
I'm a lot more open to the idea of national health care for the under-65 than I was before these two fancies popped into my mind.
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