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Flat Tax? Single Payer? Find Those Easy Answers

MANAGED CARE May 1999. © MediMedia USA
Editor's Memo

Flat Tax? Single Payer? Find Those Easy Answers

John A. Marcille
MANAGED CARE May 1999. ©1999 Stezzi Communications

John A. Marcille

Intelligent and articulate. Those are two adjectives I can use to describe Steve Forbes, a man who thinks he should be president of all the country.

I try to get to the National Managed Healthcare Congress every year because many speakers share their knowledge of cutting-edge health care issues. I get to meet people I've only spoken with on the phone, and make new connections as well. There's also the freak factor: famous people with a message or a mission. Last year it was a debate between Jack Kemp and Mario Cuomo; this year, an address by Steve Forbes.

In the last election, Forbes was dismissed as a single-issue (flat tax) candidate. This time around, he has ideas about health coverage, and had the nerve to speak to these folks, most of whom make their living off managed care, about the virtues of medical savings accounts, disconnecting employers from health insurance, and so forth. He received polite applause.

One West Virginia physician told the candidate that the major employer where he lives gave employees a health care allowance much like an MSA. Folks spent it "on new pickup trucks and wardrobes," and at the end of the year, doctors were struggling with a mountain of unpaid bills. Born with a silver spoon in his mouth, Steve Forbes doesn't have a clue about the likely social effects of his programs.

A hundred eighty degrees away from Flat-Tax Forbes lies the movement for a single payer, subject of this month's cover story. There are plenty of good arguments for this funding mechanism, but there are many arguments against it and I doubt we'll ever have a single payer. However, we do need to address the problems that such a system is intended to solve.

But let's say that there's a depression and some wild leftists (no folks, Clinton is a centrist) take power and enact a single-payer system. Death to managed care, you say? I say the recent experience of the Medicare program is a clue as to how the government would treat managed care. Come to mama!