To Sens. Jim Webb and Mark Warner

Re: Healthcare

Gentlemen,

         First and foremost, I believe two things.  One, that my health, your health, and the health of our fellow Virginians should not merely be a line item to a for-profit industry.  Operating for profit always creates an “in-group” and an “out-group”, in which the corporation need only respond minimally enough to the needs of the in-group to retain them as investors or customers.  For the healthcare industry, this not only means that rationing of care takes place (i.e. preexisting conditions) where unprofitable, but people themselves are rationed when they are ineligible for health insurance.  No one should be relegated to the out-group simply because of accident, circumstance of birth or wealth, or an economic downturn.

         Along those lines, my second belief is that at this stage in our country’s history, it is a disservice for our government, which is constitutionally tasked with promoting the general welfare of society, to tolerate a system in which the richest nation in the world either cannot provide care to its hardest working citizens or provides inadequate care vis-à-vis other industrialized nations.

         Franklin Roosevelt in 1944 outlined an “Economic Bill of Rights,” saying “true individual freedom cannot exist without economic security and independence,” naming the rights one has to competition among businesses, an adequate industrial job, a home, and protection from accident, illness, or debility.  Indeed, how can we be expected to fully exercise our constitutional freedoms if we are too infirm to participate productively in society?

         To me, the key to healthcare reform is to ensure choice: choice of doctor, choice of insurer, and even the choice to purchase care from the government if the private sector is too expensive or inadequate.  I am in favor of a mandate for employers to provide coverage for their employees, or else pay them the monthly minimum amount to purchase the least expensive regional form of coverage.  The government’s plan, rather than edging out all private competition, could be the insurer of last resort for millions of families, albeit one whose quality of care and whose ease of enrollment would preclude stigmatization.

         To pay for this, new revenues must be raised.  Some conservatives are arguing that we should cut spending, and I cannot disagree with that in principle.  But the actual act of reducing spending is nearly impossible for this Congress.  The singular question is: what do we cut?  As a Virginian, I enjoy being able to ride Metrorail into the nation’s capital, as I’m sure Marylanders do as well.  But if funding for Metro were put before representatives of the other 48 states, they would unflinchingly exorcise it from the budget as pork spending.  Repeat that process for federally-funded projects all around the country and the critics will clash with the defenders in such a way that nothing ever really is eliminated, no matter how small a constituency it serves.

         I do, however, advocate the implementation of pay-as-you-go legislation to limit the soaring deficit.  Although it may preclude valuable projects from being supported by Uncle Sam’s pocketbook, it would also force lawmakers to prioritize budget items at the national level.  In the interim, though, taxes must ultimately be raised to pay for this expansion and the aftereffects of a $787 billion bailout and years of deficits under the Bush administration. 

         I would argue that the best target is the federal gas tax, currently at 18.4 cents per gallon.  Raising this tax gradually and substantially would not only increase revenues for this particular undertaking, but would promote numerous agenda items of the Obama administration: reducing dependence on oil (foreign oil particularly), providing down payments on new renewable energy and mass transit projects, replenishing the Highway Trust Fund, and encouraging people to drive less frequently and thus reduce carbon emissions.

         There is no obvious solution to fixing health care and there are many pitfalls to each approach.  What I hope you will support is a plan that reduces the discretion of insurers to extort those who need care the most and that covers every individual from cradle to grave without indebting the nation further.  Expanding freedom of choice is key way to ensure quality of care over profitability, and a dedicated funding mechanism that cuts across legislative priorities will be both efficient and effective.  This momentous foray into reform need not be perfect, but it must be better than where we are today.