Taxes
Look: Democrat, Republican, Liberal, Conservative, MAGA, Socialist; nobody likes taxes. But reasonable people understand that there are tasks better handled by the Government than by “pay as you go” private industry. It’s “No Taxes” until your house is on fire. Then it’s how quick can the fire department get there to put it out.
So when the Republicans in the Congress look to “cut taxes” by cutting Medicare and Medicaid, like they are doing in Trump’s “Big, Beautiful Bill”; on the “surface” it might sound OK. If you’re not sixty-five (or you still have employee insurance), or your family of four makes more than $78000; those cuts are “no skin off your nose”. Or are they?
Care
It would be easy, at this point, to give you my “standard”, Democratic/Liberal rationale for why health care ought to be a right, not a privilege. I would tell you that any modern nation that fails to take care of the health of their citizens is failing as a society. I would point out that every “first world” country on Earth, from Canada to Germany to Japan, sees healthcare as a basic human right. And you might respond that in those countries healthcare is “rationed” by waiting: waiting in line for an appointment or an elective surgery.
I would respond that here in the United States we also “ration” our healthcare. We do it by the capacity to pay for it. So, instead of “all people are created equal” for healthcare, it’s a “cash on the barrelhead” system. Don’t have the cash, well, as Iowa Senator Joni Ernst said, “We’re all going to die”. You go first.
No One Dies
We know that. Go to the doctor’s office, or for a test, or for a procedure in the hospital. The very first thing you do, is make sure the bill will be paid. I remember when I was coaching middle school wrestling by teaching kids on the mat, and a young heavyweight countered my move with an elbow to my mouth. My tooth went through my lip, and I needed stitches. As I stood before the counter at the emergency department, the attendant took my through all of my insurance coverages, making sure I could pay. When she couldn’t understand my answers (after all, I had gauze compressed against my mouth), I finally had to just bleed all over the desk, and give her the “correct” responses. It was my proverbial “cash on the barrelhead”, my admittance to get care.
But, your response should be that “no one dies”. If someone shows up at an Emergency Department with a life-threatening condition, they are treated no matter what. And I’ll drop my head, and agree. But that stills leave the question – in our “cash on the barrelhead” system, who pays for them?
The Bill
Well, Medicaid does right now, for those under a certain income level. And Medicare pays for most of those over the age of sixty-five. But for those who don’t qualify now, or for all of those millions (10.9 million according to the Congressional Budget Office) who won’t have insurance after the “Big, Beautiful Bill” passes; where’s their “cash on the barrelhead” coming from?
The answer, just like taxes, is from you and me. While most of our hospitals are considered “non-profit” organizations by the IRS, they are in fact, more business than fire department. They need to cover their costs. And when a patient doesn’t have the capacity to pay their bill, then the rest of us “chip in”. Of course, no one passes the hat at the hospital to pay for them.
The “business” of the hospital simply raise all of the prices for procedures, medications, “room and board”, and service. So each of our medical bills (paid by our insurance), increases to cover the cost of “indigent care”. Those costs go up, and as everyone with health insurance knows, so does the cost of that insurance.
Out of Our Pockets
So cut Medicare, cut Medicaid, and what happens. Well, those folks without insurance will go to the “back of the line” for most healthcare. They won’t be able to get preventative care, or “elective” procedures. Their lack of “cash” to put on the proverbial “barrelhead” puts them last. And when those medical conditions that could have been prevented become life-threatening, then they end up with the most expensive care our medical establishment offers: emergency care.
And we all pay for it.
If you look at what’s gone up more in the past decade, taxes or health insurance, my bet is you’ll find that insurance is the “winner”. And when we take millions out of the “already paid for” column, and make the hospitals ante up for their costs, whose really eating that?
We are.
For many, the cost of insurance is in the “top five” annual expenses, along with housing (mortgage), food, and taxes. What good is a $1600 a year tax savings by the “Big, Beautiful Bill” (per the CBO), if health insurance will eat that and more?
It’s bad medical care and health policy. And, it’s just more of our money out of our pocket and on the medical “barrelhead”.
