CHARLIE MITCHELL: Issue is not health care, but who pays for health care




Fred has four children. As they head out to the bus stop each Monday morning, he gives each one $10 for snacks and incidentals. Question: How much cash must Fred?

The math is not difficult.

And, in general terms, it illustrates how the payout side of health care in America could work.

In other words, the total cost is predictable.

The Kaiser Family Foundation reports that per capita health spending in Mississippi for 3 million people was $6,571 in 2009.

So, if it was Fred’s job to pay everybody’s medical bills, he would need 3 million times $6,571 in his pocket every Jan. 1. That total – roughly $20 billion – would have covered it. No muss. No fuss. Done and done.

Now open-ended entitlements do exist. The total needed for jobless benefits or food stamps depends on how many people are out of work and unable to support themselves. In a robust economy, these expenses shrink. In a bad economy, they grow.

Health care isn’t like that. Even though the sources for the money vary, the total needed can be calculated.

The Affordable Care Act represents a strong stride in the direction of a single-payer system. But for the foreseeable future, the costs of health care will continue to be covered by a combination of personal funds, private insurance funds, taxpayer funds and write-offs by medical groups for uncompensated care.

“Complicated” doesn’t even begin to describe the maze.

Neither does “profiteering.”

Even calculating the per capital expenses was complex for the Kaiser Foundation – the research and philanthropic arm of a company devoted to analyzing risks.

The first difficulty was adding up all spending for public and privately funded personal health care services and products. Next was a decision to have the total not reflect preferred provider and other discounts and not include medical administration and research costs.

Clearly, Kaiser wanted a realistic figure. Most Obamacare discussions have been about something else.

The administration has tried to focus the spotlight on “availability” of health services, playing the pity card by showing people bankrupted by medical expenses. Availability is an issue. About 15 percent of Americans are not enrolled in any public or private health insurance plan.

But the vastly larger consideration is who will pay – both the total and how the total would be apportioned.

We were told Obamacare would pay for itself, would result in “savings.”

But it won’t.

For the poor – those who simply cannot pay – Medicaid has been available in Mississippi and nationwide for nearly 50 years.

For the next tiers – the “working poor” and the “middle class” – there have been some public and some private options if employer group plans were not offered. But before Obamacare became law, there was no requirement that people obtain health insurance. There is now, and the U.S. Supreme Court clearly has declared it to be a tax, even though Congress refused to call it that.

Many cooks – too many cooks – got into the action in drafting this law.

Since the roll-out, a lot of attention has been focused on the nonfunctioning website. Some attention has been focused on “sticker shock;” some has been on the president’s repeated pledge that people who liked their coverage would be left alone.

But long term, the central challenge with Obamacare is going to be the same as it has been with the IRS code. From the years when almost everybody paid into the pool, the political imperative to make the “rich” pay more and the “poor” pay less had led to half of the adult population paying nothing these days.

Obamacare doesn’t even start out like Fred, with money in his pockets to pay what’s due.

An honest system – one that collected what’s needed to pay medical costs by ability to pay and, in turn, fund health care – was a bridge too far.

And the result – unless the legislation is improved – is that along with anything else our children and grandchildren may inherit, they will also be getting our medical bills.

Charlie Mitchell is a Mississippi journalist. Write to him at Box 1, University, MS 38677, or email

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    Even though I support the AFCA and a move toward a more ‘social’ model like the other countries within our economic tier, I agree with a lot of what is said here. The discussions around the AFCA and so far the implementation have been a mess. Plenty of blame to pass around.

    The challenge for us is now addressing those issues and bringing a better system to ourselves. All ‘social’ health care systems globally offer the option to purchase private health care – the same as Medicare Part ‘X’. This is the way I believe this system could work well if we moved beyond our prejudices, replaced Medicare with a socialized medicine system, replaced the Medicare tax already coming out of our paycheck with this new tax (probably a bit higher), and move on.

    The issue in the room continues to be demonizing opposing forces. Let’s look at President Obama for a minute. It’s ridiculous to assume that President Obama intentionally wants to destroy our economy or our nation’s health care system. I won’t even discuss that nonsense. So, what selfish motive could he have? Here’s an example: African American men with prostate cancer have a significantly lower survival rate. It goes back to the same thing shown to benefit pretty much all health care issues, prevention and early diagnosis. The same demographic in turn has a higher chance of being uninsured. Can we start with assuming that Pres Obama wishes to benefit those in his own demographic?

  • Abner

    Well, Well, Mr. TWBBD, fancy meeting you here. Perhaps you should amend your argument to state that Mr. Obama is UNINTENTIONALLY destroying the country….you could use the examples of Fast and Furious, Benghazi, IRS, etc. to show that he is unaware of what is going on in his administration.

    I compliment you for bringing up the Single Payer System….many observers argue that AFCA was designed to fail in order to get to that end, that is, that AFCA would be so destructive that the single payer system would be attractive to the public, and indeed it will to the multitude that has already become accustomed to receiving federal aid in their daily lives. So let us look at the closest example, our neighbor to the north, Canada.

    Canada has a single payer healthcare system…their healthcare spending per
    capita (2011) was $4445 vs $8233 in the US. Canada’s total revenue in
    2011 was 245.2 billion dollars (deficit of 26.2 billion) with 113.5
    billion from personal income taxes. With a population of 35 million, the
    total tax burden is $7000 per capita, $3242 per capita in personal
    income taxes. Soooo, the entire personal income
    tax revenue in Canada is not enough to pay for the single payer
    program. Healthcare providers in Canada are mostly practitioners with
    few specialists. 2011 was also noted to be one of the deadliest years
    on record in Canada with a large number of deaths….which was said to
    be because of an extremely large number of elderly deaths (or an aging
    population, as they put it.)