Report from the future: Health care in the year 2024

By Richard E. Ralston
web posted October 25, 2004

The Presidential Election in 2024 might hinge on the present
health care crisis, but none of the candidates have been able to
propose any solutions.
 
The band-aid since the last Democratic Administration (2016)
has been three increases in the "temporary" health care surtax on
households with incomes over $200,000 per year. The marginal
tax rate on these households has reached 90 per cent. There is
symmetry here as this group now provides 90 per cent of tax
revenue, up from 35 per cent twenty years ago. I.R.S. officials
are at a loss to explain why the incomes of these taxpayers have
been declining in recent years. Mandatory health premiums for all
Americans-including those who have opted out-have therefore
increased 30 per cent each year.

The chief problem remains costs. These flattened out briefly in
2017 and 2018 when means testing was introduced and those
with incomes of $80,000 or more were removed from both
Medicare and all government health insurance programs. Rapid
increases in cost resumed by 2019.

The crisis accelerated after the nationwide, 8-month walkout by
the American Federation of Nurses and Health Care Workers in
late 2019. The parallel strike by the larger Hospital Accounting
Workers Union resulted in a doubling of health care payroll
costs. (Both unions won an exemption from the income ceiling
for eligibility for government health insurance.) Public reaction
swept the Republicans back into the White House in the 2020
elections. President Bush has not yet been successful in passing
her cost control legislation. An attempt was made with the
creation of the National Waiting List Data Base to increase the
efficiency of establishing rationing for surgery and special
treatments. This was defeated when Bush refused to exempt
certain "politically correct" diseases. The pleas to address the
crisis of increasing death rates from delayed treatment of heart
conditions went unheeded. A compromise bill eliminating all
benefits for smokers was passed.
 
Americans are still free to opt out of the National Health Equality
Plan. But since government physicians were exempted from
liability, the average liability insurance premium for the few
remaining private care givers has risen to $600,000 per year for
physicians and $4,000,000 per year for surgeons. Private health
care is therefore an option only for extremely wealthy patients-
mainly from Europe and Asia. Litigation has dried up to the point
that, in desperation, the National Trial Lawyers Association is
now lobbying for the complete elimination of government health
care in favor of unrestricted laissez-faire medicine. This has
precipitated the greatest internal struggle in the Democratic Party
since the Vietnam War.

One bright spot has been the relatively modest increase in the
cost of prescription drugs since the failure of six of the top ten
American pharmaceutical companies. Europe and China now
manufacture 90 per cent of our prescription drugs. Since patents
of American drug companies were eliminated, foreign companies
have dominated the market. They were only held up by the need
to wait for American companies to first pay the high cost of
obtaining FDA approval for each new drug. The rapid decline in
the introduction of more expensive and revolutionary new drugs
has helped. On the down side is the explosion in the cost of
vitamins since the FDA began regulating them. A federal court
recently ruled that the "right to health care" requires new drugs
(whose rare components are very expensive to produce) to be
provided to extend the sex lives of those more than 100 years
old-a bad sign for cost control in the future.

President Bush maintains that her goal is to "save" the system.
Her opponent runs against his own Democrat platform. He
caused a major disruption during his acceptance speech when he
said "We must face up to the fact that the federal government has
failed to deliver adequate health care to the poor, even at the
cost of destroying it for everyone else." Neither candidate has
yet provided specific remedies.

You can't figure out whom to vote for? You can't figure out how
the hell we got into this situation? You might want to look back
at a few previous elections.

Richard E. Ralston is Executive Director of Americans for Free
Choice in Medicine www.afcm.org. Comments to
mail@afcm.org.

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