Form 1

Have you wondered what it might *really* look like to have national health care?

In the Commonwealth of Massachusetts to file your state taxes you file "Form 1", Resident Income Tax Return. In addition is this note:
IMPORTANT: Schedule HC, Health Care Information, MUST be filed with Form 1. Failure to do so will result in a delay in the processing of your return.

Schedule HC is how you declare to the Commonwealth that you are a law abiding, health care buying citizen. Just like with income derived illegally, you must declare it, and failure to do so and pay any associated penalties, well you could end up like Al Capone. It was ultimately tax evasion that did him in, maybe gangsterism is harder to prove.

On Schedule HC you must state that you have MCC, Minimum Creditable Coverage. If your income is less than 150% of the Federal Poverty Level, you are exempt. That level is around $16K for an individual, or $33K for a family of four. There is a religious exemption too; I suppose this is for Christian Scientists and those that believe, truly believe under penalty of perjury, in faith healing.

Any exemption must be granted by the Commonwealth Health Insurance Connector Authority (really!) If you don't have a viable exemption, then did your employer offer you affordable health care that met the minimum creditable coverage requirement? If not, then I suppose they will go after the Walmarts of the world.

If so, and you didn't get it, Go To the Health Care Penalty Worksheet to calculate your penalty amount. It is a sliding scale, so not to worry. If you make more than $54K you are assumed to be able to afford health insurance. The premiums you are expected to afford are scaled based on age, e.g., age 21 - $156/month, age 52 - $338/month, age 63 - $445/month.

Your penalty, if this should befall you, is also scaled - see Table 6. It can range from $418 (21 year olds who try to scam the system) to $696 for seniors.

Enforced through the state tax code. Ratchet this to a national tax system. I am ok with that, and do believe our destiny as a nation is to have a national health insurance plan. It is inevitable, it will make us and our companies globally competitive, it is morally right, and All Those Things. Those that would oppose this destiny are what - out for scaling back all of what government offers? Like an onion? What is left when you scale back the layers of the onion - more onion. So what have you gained? Get with the program already. But I know, they are only doing it for political gain. As so much of what is done these days - under false premises.

The last day the Senate was in session was Thursday 3/24. A small business bill was up for reauthorization. Lots of interesting amendments which have nothing to do with the small business handout, er, "incentive funding" bill. One of them, offered by Senator Kay Bailey Hutchison, would cause the health care reform effort to stop-in-its-tracks, until all the U.S. vs. State lawsuits are settled. Again, playing this for political gain.

Health care reform, just say yes. If not now, tomorrow; if not tomorrow, then it will be in a future that is coming to you. Unless of course you have some rare disease that is a pre-existing condition, you can't get coverage, and you kick the bucket first. But its coming to a street you live on, just a matter of when.

All In

The problem with part-time solutions..

Health care. Arg, so many things are working against this one. Compromise is not always a good thing. Lets count what is going wrong: premiums are up (double digit up). Families are dropping off, and companies are reducing the number of people covered. While I have my nice cadillac benefits, for the moment (not even for the biennium, I don't think those nice union-negotiated-contracts exist for us management service dweebs). No guarantees here, and the secret budget the current Gov is working on (does not need any messy state agency help! ok then!) we shall see.

Just today someone I work with jumped ship. Announced his retirement effective the last day of the month. Effectively giving 3 days notice. Now he's probably been there 30 years or so, this is actually *not* uncommon, though I cannot imagine it. I've been there nearly 3 years. For me, 4 years is a work record. One of the proposed PERS pension reforms would have reduced his benefits 20%, so yes a sensible decision.

What else is going wrong with health care - the cost of medicine is up. The spectrum of cspan callers-in is wide. Today someone calling in representing the widows of the nation. She has seen no cost of living increase in social security payments for 2 years running. And the cost of her medicines continues to go up. She sounded angry, but also tired, also hungry, also very frustrated, also anxious. If you listen to the radio hours a day you can learn to recognize these things in voices. Or, like, which senator is speaking. Now, if pharmaceutical companies didn't spend 20% or is it 50% of their budget on marketing directly to consumers, maybe they could actually deliver sensibly-priced drugs that people actually need. Right now none of those adjectives is true.

What else - doctors. The number of doctors is not keeping up with demand, as the baby boom crowd ages and needs (or is told they need?) medical care. I ask whether they need this, since I have a 90-year old neighbor who does not have a doctor. By now he is probably 92, and he is still out trucking around. Maybe that is the key to a long healthy life - do not have a doctor, do not interact with the medical establishment. Just wondering.

Part of the doctor supply issue may be that Medicaid and even Medicare rates do not keep up with their costs. Thus doctors do not want new Medicaid and Medicare patients. Making it hard if you don't live in a metropolis, but in some Eastern Oregon town, say. Despite all the tax incentives and expenditures out there to lure medical professionals to these rural areas. Note to self (and to anyone else out there): look up the most recent Tax Expenditure report. A useful and insightful publication, published by the State Department of Revenue. Whatever else they do that you might not like, they do make a vast range of data available to the average citizen.

Doctors are also beset by medical malpractice rates. And high loan fees from their education..

That is Part 1 of how a half-way compromise solution ends up satisfying no one. The Next Health Care Solution will have to be All In. None of this part-way stuff. Go for it, Obama! Full scale national health insurance, like a real developed industrialized nation. Do we still qualify as one of those?