An Obamacare Final Exam
Hank Adler is my co-author on The Fair Tax Fantasy, and he raises some very basic questions as the big denate on Obamacre opens this week:
Finals are approaching in most universities and high schools throughout the country. With a 2000 page Senate Healthcare proposal, it is unlikely that anyone could pass an examination on the specifics of the legislation. However, we should expect that the members of the United States Senate should be able to pass an examination regarding the general aspects of the current Senate proposal. Below is a series of essay questions, each of which should be answerable on two pages of a blue book, which should be presented to each member of the Untied States Senate:
Questions related to the overall economics of the Senate proposal:
1. Including the proposed tax increases, the current proposal is promised to be revenue neutral over the first decade. Are there any recently passed Senate bills or future Senate proposals which will positively or negatively impact the revenue neutrality of the current bill? If so, how do/will such bills impact the revenue neutrality of the proposal? (Please include a discussion of any current proposals to permanently improve doctor’s compensation under Medicare.) As perhaps the strongest argument supporting the current proposal is its revenue neutrality, is it appropriate for each Senator to commit to vote against any future proposals which would increase healthcare costs?
2. The current bill is not revenue neutral after year ten, what revenue increases or expenditure reductions would you propose and/or expect beginning in year eleven to pay for the healthcare proposal?
3. Over $400 billion dollars of new taxes will be collected during the first four years of the Healthcare proposal without a significant expenditure of funds. What are the underlying economic theories supporting the raising of taxes in the midst of the most severe recession in over fifty years? (Please include a discussion that contrasts the current proposal with President Hoover’s increase of taxes during the early years of the Depression.)
4. Assuming that a public option is included in the final proposal, please identify the timing and impact of employment in the private sector versus the public sector for the healthcare system. Please identify concerns and solutions with respect to geographic dislocations and system creation issues.
5. Given that several states, including California, are currently virtually bankrupt resulting from systemic budgetary issues, please explain the significant expansion of state funded Medicaid requirements in terms of the financial viability of such states.
Questions regarding the health delivery impact of the Senate proposal:
1. The Senate proposal anticipates increases in preventative care and increased access to the healthcare system outside of free clinics and hospital emergency rooms. Please explain how citizens without sufficient funds to pay the required co-pay included in virtually all insurance policies will be accessing the healthcare system under the current proposal.
2. Please explain why the exact coverage to be required and the amount of co-pays is not specified in the legislation and why that lack of specificity does not cause you to be concerned as to the cost estimates and ultimate access to the healthcare system.
3. Please explain the impacts of the current proposal on charitable contributions to hospitals and clinics in the United States and indicate whether these organizations will be viable with any decrease in contributions anticipated. What do you see as the continuing role, if any, of charitable organizations or free clinics in general after implementation of the current proposal?
1. Please explain why the current proposal is preferred over either of the following other options:
A “Marshall” type plan to train doctors and nurses wherein the government would provide loans to all individuals being trained which would therefore result in minimal costs over the ensuing decades or
The creation of government operated free clinics throughout the country providing preventive care etc., therefore avoiding all of the accompanying complications of the insurance driven strategy encased in the current healthcare proposal.
2. The President has indicated on several occasions that the current proposal is nearly identical to state requirements for auto insurance. However, in many or most states, there is a state requirement to carry insurance for uninsured drivers, which indicates that a significant percentage of the public is not carrying legally mandated auto insurance. What is the underlying data indicating that (1) with penalties for individuals not carrying insurance being drastically lower than the cost of insurance, (2) the requirement for co-pays that many poorer Americans simply will not be able to pay, and (3) the continuing requirement for hospitals to treat individuals in emergency rooms regardless of whether they have insurance, Americans will decide to purchase the insurance being offered? What data supports a result that more Americans will be covered following passage of the proposal? (In your answer, please include a discussion of the ability to get coverage regardless of current health as an incentive to individuals deciding to pay the penalty rather than carry health insurance.)
3. What is the underlying data that demonstrates that Americans who are currently uninsured because they have not completed sufficient paperwork to be insured under current governmental supported plans will complete the new forms under the proposal?
4. Please define the term “insurance” in the context of the Senate healthcare proposal. In your definition, please differentiate between automobile and homeowners’ insurance where if one is fortunate, he or she may never make a claim and the insurance expected in the Senate proposal.