Hey Grads: Feeling Sick?

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Obama's latest mission impossible (I often like to think of him wearing all black and hanging from the rotunda of the Capitol by wires, ready to bust into a vault full of legislation) is the health care reform elephant. On Sunday he repeated something we all intuitively know. "The status quo is broken. We cannot continue this way," he said. "If we do nothing, everyone's health care will be put in jeopardy."

He wants a health care bill on his desk by August, a laughable goal given that he has to jump over 535 whiny legislators, several thousand lobbyists and interest groups and a public largely not engaged in a movement to cover 50 million uninsured and cap costs in a way we can all live with. It's a laughable goal because so many have failed before in spectacular fashion (sorry Billary). But given Obama's popularity and momentum this year, he has to try.

For most people, health care policy is both boring and way too complicated. Students are, compared to the rest of the population, a healthy bunch unless they're stupid enough to sleep around without protection. And they've never had to pay for their own health care, so why should they pay attention? Well, if your worst nightmare is being unemployed after graduation, imagine instead being unemployed, then having your parents tell you they can't afford you on their plan anymore, then finding out that you can't afford to insure yourself. Tang will seem like the Mayo Clinic pretty soon.

I can break down this health care debate for you by listing a few basic questions that will come up as you read about this in the next few months:

Do we need an optional government-sponsored health plan?

Obama says yes, the health care insurers say no way. It's funny how these insurers played ball with the administration as long as they thought they were going to reap more profits from getting 50 million new customers onto their rolls and having the government pay for it. When they realized the government might actually provide insurance more efficiently than they do, they cried foul. They're now lining up money and TV ads that you may see in the next few months aimed at shooting down this option. Insurers first said that government-sponsored health care was too inefficient and bloated and would take away your choice of doctors. But now the government is too efficient and is practicing unfair competition because it is far larger than any other health care plan. It's one or the other, guys, but you can't have both.

Do we need an employer mandate?

An employer mandate means that every employer will either have to provide insurance to employees (with employees chipping in as they do now in many jobs) or pay a tax that will fund the government-sponsored plan. This is often called "pay-or-play," and is disliked by conservatives who believe it's burdensome for business. It's a quirk of the American system that employers provide insurance as a benefit, as if this is some privilege that only people working at well-off companies should have. Many employers are completely fed up with having to deal with health insurance and the incredible pressure it has put on their bottom line in the past few decades (ask GM and Chrysler). If this is crafted in a way that doesn't overtax small business but makes everyone pay a fair share, some employers might jump at the chance of sending their employees to the government plan rather than negotiating with bloodsucking insurance companies that have notoriously high administration costs.

Do we need an individual mandate?

An individual mandate means that we would require every person in the country to get health insurance in the same way that we require everyone to have a minimum amount of auto insurance. This is something Obama was against during his campaign (Clinton was for it), but now he's changed his mind and wants to consider it. But we all know getting health insurance isn't like getting that $50 a month bare-bones policy on the crappy Nissan you inherited from your shady uncle. Health insurance for families now runs into thousands of dollars a year, so until those at the poverty line can get a policy and still feed their kids, a waiver or some other arrangement has to be put in place. How about this: If you can't afford your own policy, you get one via the government plan by having a reasonable amount taken out of your paycheck (or unemployment check) in taxes, just like we currently have for Social Security and Medicare. So everyone pays a fair share into the system, and nobody gets a free ride. It's not welfare or socialism, my heartless social Darwinist friends out there, it's called making a prosperous society.

Do we have a moral obligation to provide health care to everyone?

I have tried to see the other side of this. I have tried to understand those who say that health is just another commodity, and why shouldn't those who worked hard for their money have better health just like they have better HD televisions? But frankly, that attitude is about as un-American as it gets. We are a rich country with some of the fattest and sickest people in the industrialized world, and both Democrats and Republicans should see that as a badge of shame we need to tear off this year.

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