Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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(3) Obamacare: Speeches
New topic 2015-09-25 21:48:47 description

REPLICATED COPY of Three Segments of Lifetime Healthcare, Starting With Medicare 07/12/16 11:16 pm

Healthcare can be divided into many different segments. We choose to divide the discussion of it into three eras of life (childhood, adulthood, and retirement). Because the Affordable Care Act ("Obamacare") is in political and judicial flux, we must skip adulthood until it settles down. For discussion purposes, we regard the healthcare of working people as a fairly small issue, so it can temporarily be treated as cost-neutral. Keep in mind that the financing of all stages and conditions of life ultimately derive from working-age people, however. Children, retirees, and disabled persons are ultimately subsidized by working people because these dependents have little income of their own. We aren't skipping over that fact at all; it's the actual health costs of working people that are too unstable to discuss, just yet. Forgive us if we pass over them for a few months.

The Affordable Care Act purported to mandate health insurance for everyone, but actually, about thirty million people were excluded. The healthcare of seven million prison inmates, eight million unemployable, and eleven million illegal immigrants are too specialized to be included in a program which hoped to be one-size fits all. Quite properly, these outliers would be better handled by special programs, designed for their special needs. That's all that needs to be said about conflict with the Affordable Care Act, for the present. If the ACA conflicts with some of the imperatives of what we outline, we assume it will be changed. After all, that's been its philosophy from the beginning.

What that leaves to discuss is retirement, childhood, and how to connect the pieces. It's no secret all of lifetime healthcare in our scheme should be connected by a single lifetime Health Savings Account, one per person. We'll return to that after we first discuss the dependencies of retirement and of childhood. They are quite different. Medicare is not only a political hot potato, but it also comes at the end of life after savings have accumulated to pay for it. Childhood comes at the beginning of life before there has been much chance to pre-pay it. That makes such a radical difference, they almost seem to make them two different programs.

We begin the far end of life, where most of the health cost concentrates, and paying for retirement is a vital issue. We start with Medicare, which most people don't want to change.

Originally published: Tuesday, July 12, 2016; most-recently modified: Monday, June 03, 2019