The National Catholic Review

Members of Congress have no choice, really. They must work within the constraints of what is politically feasible. But ordinary citizens need not, at least not always.

Attempting to free myself from such constraints, I have temporarily put aside all the big-picture proposals currently being discussed, and which I think have merit, like:

• extending health insurance to virtually all of the uninsured—by extending the reach of Medicaid; by mandating coverage, while providing subsidies to very small businesses and individuals with low-incomes; by fining individuals without insurance and employers who do not provide coverage; by taxing health-related products and industries; and by ending the Bush tax breaks for the wealthiest Americans, soon set to expire

• funding comparative effectiveness research, so that research compares new procedures and drugs with each other (not just with a placebo or with one other competitor) and also with current procedures and drugs to determine which work best. It isn’t always the latest thing.

I also support proposed measures to finance the reform, like

• replacing the procedures-based system that Medicaid currently uses to reimburse healthcare providers, with a care-based system—the quality vs. quantity argument. This sounds like an improvement whether it cuts costs or not.

• moving to electronic record-keeping, which would improve the efficiency of care  by eliminating duplicative record-keeping and tests, and give a variety of physicians  access to the same information. Safeguards for patient privacy and security would also have to be instituted, though, which could add costs unless Congress has already accounted for this in the bill. But electronic record-keeping promises benefits, even if it doesn’t reduce costs by as much as some have suggested.

•setting up a public insurance plan, that is a nonprofit government-run plan, so that consumers would have it as one choice among many private plans, and it could determine what the actual costs of coverage are, what is needed when and where, and serve as competition for private companies. Right now, there are only a handful of major insurers in some areas of the U.S., which makes choice of insurer very limited. As for a cooperative mix of for-profit and non-profit plans that are not run by government, why not have that as well—only without government subsidies, since the argument against the public plan is to keep government out of private business.
 
Meanwhile, however, perhaps as a frustration-coping device, I have begun to wonder what I might propose if anyone asked me (unlikely). Brainstorming requires the freedom to consider even the wackiest, most implausible ideas. My contention is that if enough citizens seriously engaged in it, someone—perhaps an America reader—might come up with an idea that is both helpful for reform and feasible, and which is new and worth broadcasting. The real crux is paying for reform—something the general public seems less and less willing to do. So please offer your own wild ideas on that topic in the comment space.

Three wild ideas for financing the reform:
1. A sugar tax: Yes, this notion comes to you from a perennial sweet tooth, and it builds on a proposal that has already been considered publicly as a health-related way of paying for the reform, a tax on sugary soft drinks. Some critics of that notion asked, why us? why would soft drink makers be saddled with such a tax? Hmm, I thought. They’re right. Why not extend the scope rather than throw out the idea completely. Why not levy a small tax on every product (from candy to breakfast cereals to soft drinks to wine—every food) that contains sugar above a certain percentage or that exceeds set amounts. Or it might be structured so that the more sugar an item contains, the higher the tax. Some qualified team of physicians and nutritionists, for instance, could work out reasonable, health-based standards, and legislators could fine-tune the details.

If every consumer paid something small (a penny per item, say—six cents on a pack of soft drinks or a box of chocolates), the money raised would go directly into the government’s revenue stream for health care. We would get the money back in services and benefit from better, more extensive care and coverage. This little tax would earn money year after year, even as it raised public awareness of the health dangers of too much sugar and, one hopes,

The Reason: while sugar in moderate amounts is not harmful to health (any more than liquor or alcohol is), many products contain quantities of sugar that make it a prime contributor to rising diabetes and obesity, which are enormous health concerns, and increasingly so for children. Or the products are consumed in such quantities that they become a health risk. We have a liquor tax and a cigarette tax to help combat particular ill-effects, why not a sugar tax designated solely as revenue for health care?

2. A health bandwagon: The government wouldn’t have to initiate this bandwagon, but it could. Or it could just augment the work of other groups and individuals. If you are old enough, think of the “President’s Physical Fitness” program that John F. Kennedy sponsored in the sixties. Or of private groups like Weight Watchers, AARP, health clubs, product sponsors and advertisers, as well as church and civic groups—all of which could promote in a new way, with a national focus on health, “healthy habits” like a health eating and exercise. A new bandwagon is an idea anyone or any group could run with, promoting creative ways of involving parents, children, teachers, seniors, and all other Americans. And it could involve millions, inspired to get on the bandwagon.

Since childhood obesity is on the rise and can turn into diabetes and a lifetime of illness, it should be one of the first issues addressed. Something for Michele Obama to stand behind? Or some child stars?

The trick would be to keep such a campaign positive, lest public sentiment turn negative against the overweight, the ill, or the old. The idea would be for each American to  “do something more,” to take personal responsibility for prevention of disease and to improve their health—whatever it is. Those who are ill or suffer a chronic condition would merit society’s applause, and improved health, by doing all they can to lessen the ill effects.

The Reason: This program would focus on societal good. Getting in better shape would be seen as a patriotic act, not merely as good for each individual. The population would be respectfully invited and encouraged to do its part to improve the nation’s overall health and fitness, getting ourselves “in better shape.” That would be a boon if it could motivate citizens to take responsibility for constructing the society we want to live in. The long-term rewards:  generations of healthier Americans more active in constructive government.

3. Add a line to the federal IRS form—a little box taxpayers could check so that  $1 from one’s tax refund goes to health care. I’m not kidding. I realize that there are zillions of important and worthwhile causes that taxpayers could support and that dozens of charities are facing hard times in this distressed economy. But health care is a national priority that begs for universal support. I even realize that opponents of the reform are balking at the costs, to the point of denying the need for reform, despite all the evidence that shows it is imperative. Putting a “gift” option on the form would raise some money, without costing much of anything. It would also extend our role as stakeholders, perhaps the more important reason for doing it.

Comments

Anonymous | 8/12/2009 - 8:05pm
" Additionally, what food has straight sugar in it."
That's a bit like asking what alcoholic cocktail has straight alcohol in it.  If you can't see the damage that sugar overload has done, then you are just in denial or on the sugar payroll. And I suspect that blog you mention, probably is funded by either the sugar or junk food industries.  The problem with blogs like that is that anyone can write one without even revealing who they are.
You also don't mention the sugar connection with child and slave labor, [url=http://topdocumentaryfilms.com/big-sugar/]http://topdocumentaryfilms.com/big-sugar/[/url] 
Please share the name of the soda that has no sugar or sugar substitute in it?  And enjoy your diet soda, while there may be conflicting science as to the dangers of aspartame, I don't want to leave my child with a chemically unbalanced mother or an obese one because I didn't care about what I was putting into my body.
Anonymous | 8/12/2009 - 11:07am

This comment is in response to Tina Fanetti, who accused me of "blamin the overweight and the ill for burdening our health systems," which I did not do. In fact, I argued quite the opposite-saying that any bandwagon campaign should not turn negative. No author likes for her words to be twisted to say the precise opposite of a point they are making.

Nor would I recommend the blog she suggested. I spent a few minutes trying to find the article she referred to and on the way read some of the blog entries.  The underlying attitude there would appeal mainly to those who distrust the government completely, which is not something with which I agree. Like most people, for example, I think Medicare, Medicaid, and the Veteran's Administration health systems-all sponsored by the federal government-have helped millions. Nor did I find the Web site a source of trustworthy scientific information as she asserts. I wouldn't go there again. But readers with lots of time on their hands to test such things can discern its value for themselves.

Anonymous | 8/11/2009 - 5:07pm

I've paid high prices for organic foods for decades; I've used supplements and herbs and a healthy diet and am one of the few people I know over 30 who takes no medication.  Thanks to the internet, news (uncensored by news media philosophies and advertisers' interests) is getting into most American households about alternative medicine. 

The USDA is directly responsible for a lot of the obesity today because of that obscene 'health pyramid' it published in the 90s.  I heard about and thought, 'Oh, good-they're finally taking diet seriously.'  Then I read it and was appalled: it promoted as healthy a diet mainly based on white flour, known as 'stomach glue' in natural medicine circles.  They could not have done a better job at screwing up people's health, and with a fair amount of paranoia I actually wondered if it was a doctor-concerted effort to drum up more business.
So please, PLEASE do not suggest putting some industry-connected government bureaucracy in charge of health advice.  The AMA lobbies for MD's having a monopoly in the healing industry, but in the 80's the chiropractors won a ten-year lawsuit against them for antitrust activities. 

Acupuncture used to be illegal, but now is available.  We are finally getting choices because Americans have received subpar, costly help from their MDs and have pushed for the right to have choices in health care.  Now after secret negotiations, the AMA and Pharma are backing Congress's 'health care reform' but the alternatives that many Americans want were excluded from the table.

To me it would be best to leave this broken system alone because finally change is happening on its own.  I see this marriage of politicians and medical heavyweights as a concerted effort to prevent this healthy evolution from taking place.

Anonymous | 8/11/2009 - 8:34am
Any health care reform program is also going to have to deal with long term fraud waste and abuse.
Like the Iraq war, the government is going to be spending large amounts of money to solve problems.  In the Gulf war, Halliburton and othr compaines stole billions through over charging, "make work" eforts, out rigth theft etc.
Unlike the Iraq war, this governmental effort can last indefinetly and will be spending and distributing far more recesources. This gives a huge potential for "Health Care Haliburtons". 
 
Anonymous | 8/10/2009 - 8:15pm
Make it illegal for employers to provide any health care insurance or benefits whatsovever. Then address the question if people want government health care or not. The excessive costs of US health care are largely driven by insurance companies that blackmail employers into spending huge amounts of money for high-end health coverage. These expeditures destroy American competiveness in the global market and set an unrealistic expectation among all people of what appropriate health care should be. Well-educated people are typically better equipped to question doctors and make informed decisions as to whether a medication, test or procedure is cost effective. But well-educated people are more likely to have high-end coverage through their employers and so have no incentive to do so. Forcing powerful, well-educated people to make informed health-care decisions would create a strong demand for organizations like Consumers Union and the Food and Drug Administration to evaluate the relative benefits of various treatments. Then we would know if the highly advertised $500 a month arthritis medication was actually 100 times better than $5 a month asprin.
Anonymous | 8/10/2009 - 8:07pm

Why not accentuate the positive and make fresh foods like fruits and vegetables cheaper and opportunities for kids to play safely in their communities top prioirities? We could, since we're brainstorming, (1) make certain that farmers have incentives to produce foods for local consumption, and especially in public schools(2) assure that those on food assistance get lower prices for purchasing fresh foods, (3) bring back PE and the President's Fitness Challenge, (4) zone for safe places for play and exercise in communities "lazy-free zones?"and (5) encourage parents to play or teach kids simple games that we used to play outdoors to keep us active: hide and seek, hopscotch, double dutch and remember kick the can? All of this sounds a lot easier than getting into tricky political waters. Dwayne

Anonymous | 8/10/2009 - 6:26pm

Sugar is already taxed, it is subject to import tariffs.  Additionally, what food has straight sugar in it.  I'm looking at a bottle of soda, there's no sugar listed.  My diet soda doesn't have sugar in it either.  Please go to junkfoodscience.blogspot.com before you start blamin the overweight and the ill for burdening our health systems.  Research, not andecdotal evidence, shows those health bandwagon programs you advocate don't work over the long term and most times don't work over the short term. 


Anonymous | 8/10/2009 - 12:34pm
Kudos for brainstorming; still, it reflects the difficulty of the task. Everyone wants to make a profit and most want excessive profits. In our system this is usually the case as profit is the great motivation. We all have a right to food and this government has always had a program to provide low cost food; were it entirely up to just the free market and individual farmers and merchants to determine costs most of us would starve. Health care costs need to be controlled and actually are to some extent. But like food, basic health commodities need to be accessible to all. Where is Solomon when we need him?
Anonymous | 8/10/2009 - 12:06pm

All the above are merely asking for a bigger nanny government. Tobacco tax, gas tax and social security tax go to the general operating fund. Stars and celebrities are the worst source of advise for Americans. Personal responsibility comes from doing not receiving. Where does HR 3200 mention tort reform (a huge source of savings)? Answer. Attorneys are in bed with politicians and most politicians are attorneys.