My father was a country doctor who viewed medicine through the prism of the Hippocratic Oath, which embodies the ideal of “Above all, do no harm.”
A child of the Great Depression, my dad was generous when people couldn’t pay their bills. I recall sitting as a child at the dining room table with my dad, my mom and my little sister, Gayle, stuffing patient bills at the end of the month. As Dad sorted through bills, I remember him setting several aside saying “can’t pay… can’t pay.”
When I asked him why he did this, he said, “Son, if I send a man a bill he can’t pay, when he’s sick, he may not want to come see me. That wouldn’t be good.” Soon after, Medicare was created, and when my dad came home the night it passed, he sadly said, “Medicine is changed forever.” It wasn’t a compliment. Dad knew that compassion was dealt a blow when health care became the province of big government.
Sadly, history could repeat itself, as President Obama and his liberal allies in Congress seem poised to disregard the admonition to “do no harm.” Not only does their reckless policy threaten the health care arrangements of private citizens, but their prescription also bodes ill for state budgets when we are at the breaking point, something I see daily as a state legislator.
Virginia, better than most states, is laboring to balance its budget in the midst of a weak economy and amateurish fiscal forecasts by Democratic Gov. Tim Kaine’s administration. Yet Congress wants to increase coverage of uninsured persons with incomes up to 133 percent of the federal poverty level, thereby expanding Virginia’s Medicaid program by $1.7 billion to $2.2 billion. While the federal government would raise taxes and cover more than 100 percent of the cost through 2015, Virginia would be required to cover 10 percent of the cost in 2015, leaving the commonwealth scrambling to cover another $387 million in fiscal 2015-16.
Moreover, some in Congress want to eliminate the pretax savings on Flexible Spending Accounts (FSA). Virginia allows employees to participate in both the medical and dependent care FSAs. Consequently, both the employee and the commonwealth save a substantial amount — $1.7 million in state and $1.7 million in employee contributions — by not paying Social Security taxes on pretax deductions. Employees save on both federal and state taxes because those dollars are deducted on a pretax basis.
Taken together, this approaches a $6 million tax savings for Virginians that would disappear. Similar savings would be lost, too, to local governments and school divisions. Simply put, eliminating the pretax status of FSAs would increase the burden on employers and employees alike.
So what’s the answer? First, Congress needs to kill the current bill (HR 3200) and refrain from unfunded mandates and higher taxes. Second, Congress should do the following to rein in costs through real reform and free-market initiatives:
c End junk lawsuits. Tort reform has been opposed by trial lawyers — big Obama supporters — for years. But lawsuits have driven malpractice insurance rates through the roof. Our overly litigious system results in huge costs for tests and procedures that are unneeded but ordered to protect doctors’ equities. Those costs are passed to consumers. They must be capped to reflect actual physical harm.
c Permit the sale of health insurance products across state lines. There’s a reason cell phones, once expensive, are very affordable today: competition. The byzantine prohibition to selling health insurance across state lines must end.
c Permit portability of insurance. When a person changes jobs, he should be able to take his insurance with him, just like a 401(k). Also, when children graduate from college or leave home, permit parents to keep those children on their policies until the children can buy their own insurance.
c Stop punishing people for pre-existing conditions. This clearly is in the best interest of all concerned. If we want people to have insurance, we must promote access.
c Incentivize the creation of private-sector clearinghouses for billing and claims. The current system is a nightmare for doctors and patients alike. But what if private enterprise could create a clearinghouse to handle bills and claims while standardizing forms and procedures? That alone could result in clearer and more efficient business processes that would cost less and be likelier to detect fraud, which is estimated to be in the billions. Maybe then doctors could spend less time on paperwork and devote more time to patients.
All these things would help without busting state or personal budgets, and maybe provoke a smile from my departed dad, who no doubt is busy seeing an angel with a broken wing.
Republican Delegate L. Scott Lingamfelter, a retired U.S. Army colonel, was elected to the Virginia General Assembly in 2001 and is a member of the House of Delegates’ Appropriations Committee.