Some of you might know I've taken it into my head to try and design a national healthcare plan. In my pursuits I've done some preliminary research on health care as it is now and the national healthcare movement in this country (which has gone back as far back as the 1910s), the obstacles various plans have had in the past as well as how the greatest victory in the healthcare movement (Medicare) was brought about.
There are a lot of plans out there already, and all of them are for the most part a variation of a theme: Large, government run, and built around existing medical plans (Medicare) or previous plans in the last century that have failed to pass. I felt there was really a great deal of missed opportunity in designing a plan that can get broad support from across Ideologies. So I decided to base MY healthcare plan (which I have named Americare) on the organizational structure of the US Postal Service.
More on why, and what I've learned, after the flip...
Nearly all existing medical plans I've read have failed to address a single, nagging problem that comes up again and again. Can we trust politicians not to mess up our healthcare system? Depending on who's in power, who's in the white house, or shifting political priorities, a government program of any kind is just a vote away from getting the axe. We have only to look at Medicare as a prime example. In recent years, as budget deficits swell, it's funding has been cut dramaticly. It has also been the subject of a horribly failed prescription drug program (Medicare Part D) which many see as little more than a give away for pharmaceutical and insurance corporations. These are exactly the kind of programs we can TRUST our politicians to come up with.
It's with this in mind that I think, if we want a national healthcare plan that will last the test of time, it needs to be independent from government control. There are a few government programs that fit that bill but none combine efficiency, effectiveness, value, and positive public image like the US postal service. It has been a part of our country longer than we've even BEEN a country.
Here is what I have learned about the U.S. Postal service that can be applied to a national healthcare plan:
1) Independence with a mandate: The US Postal service as we know it was reformed in 1971 with the Postal Reorganization Act. This act restructured the old "Department of the Post Office" (a cabinet level department at the time) into an independent, government-owned corporation called "The United States Postal Service". With this independence, came a mandate:
The postal service shall have as it's basic function the obligation to provide postal services to bind the nation together through the personal, educational, literary, and business correspondence of the people.
- A board of Governors: The U.S Postal service has as its leadership a board of governors. There are 11 members of this board. 9 are appointed by the President and confirmed by the Senate to staggered 9 near terms. No more than 5 members can be of the same political party. This board then as a group appoints the Postmaster General who acts as the CEO of the postal service. The 9 member board and the Postmaster General come together as a group to appoint the Deputy Postmaster General. In addition, no employee of the Postal Service (including the board of governors) can have a salary that exceeds the Level 1 position of the executive schedule (which is for cabinet level officers).
- Bonds: The U.S. Postal Service, as part of the Reorganization Act, has the authority to issue public bonds to pay for the construction of postal buildings, and mechanization/technology upgrades.
- Negotiations: The Reorganization Act also gave the postal service the authority to negotiate with employees, vendors, and transportation providers.
- Postal rates determined by independent commission: An independent commission was created by the Reorganization Act. It has 5 members (appointed by president, confirmed by senate) that recommend postal rates to the board of governors. They do not have the authority to actually enact rates.
- Special legislation that guarantees monopoly and protections: The U.S. Postal service enjoys a federally supported monopoly on all first, second, and third class mail. In more recent years parcel delivery and overnight delivery has been exempted from that monopoly giving rise to such corporations as Fed-ex and UPS, however even these companies are still not permitted to deliver to or receive from facilities owned by the US Postal service (like P.O. boxes and US mailboxes). Also, the U.S. Postal service enjoys special laws that protect it from fraud or harm. Committing fraud through or against the postal service or harming Postal Service employees or property are federal crimes that carry much stronger sentences than crimes committed without postal service involvement. These sentences, as mentioned in the movie "The Firm", aren't sexy but they have bite.
Independence for a national healthcare plan is very important. With the current state of the federal finances, the U.S. Government can not afford to institute a plan as massive and, yes, expensive as a national healthcare plan. Any funds that result in a hike in taxes are in danger of being funneled to other programs that quite frankly, don't have a whit to do with healthcare. We see it now more than ever. With $60 billion cut from public services to finance an $80 billion dollar tax cut and the deficit still swells. For this reason, a successful national healthcare plan needs to be financed by a separate tax, like social security, that never sees the light of the federal budget.
The National Healthcare organization needs to be controlled by an independent board of directors with a clearly stated mandate to provide healthcare services to all people eligible for such services.
Said board of directors needs to be independent but appointed position with members qualified in the fields of medicine, finance, insurance, and healthcare. The panel itself should be able to appoint its leader and deputy leader.
The organization needs to be able to issue public bonds to finance expansions and upgrades.
The organization needs to be able to negotiate better rates from healthcare and pharmecutical providers as well as negotiate wages and benefits for its employees.
An independent panel of advisers needs to be established to recommend changes in tax rates for funding its operations. This panel can also offer oversight on the organization's financial activities to make sure public funds are spent wisely.
The organization needs to be reinforced with special legislation that makes it a federal crime to commit fraud or damage against personnel or property of the organization with stiffer penalties for such crimes.
So that's what I have so far. In many ways this feels like an economics class where they tell you to create a hypothetical business from the ground up. I never did take that class and I really don't want this to be hypothetical either so if anyone wants to join me, I'm at people.project@yahoo.com.
P.S. I need to make a website for the project and it's not going well. I really want a discussion board because the blog, found at Peopleproject.blogspot.com just isn't cutting it for me. A blog is just one person or a small group of people who talk into the ether but I really want some honest to goodness discussion on this. So if anyone is interested in helping me let me know.