The Truth, Mainly - 11/08/1993

Medically activated tax refund, anyone?
by Leon Satterfield


Did you see what Hillary said about the health insurance folks last week?

She said they were lying in their TV ads about the Clinton health care plan.

She said "They like being able to exclude people from coverage because the more they can exclude, the more money they can make."

She said it's time for us to tell them "Enough is enough—we want our health-care system back."

I've always wanted to say things like that but I've been afraid the health insurance industry would send out an all-points bulletin declaring my whole body a pre-existing condition and thus exempt from coverage.

But I don't see why Hillary's so indignant. Indignation suggests thwarted expectations. We get indignant when the local minister runs off with (a) the building fund, and (b) the choir leader. That's because we in the flock expect better of our shepherd.

But we aren't indignant when our dogs pee on trees. We may not like it, but we understand peeing on trees is doggy destiny so we just sigh, gaze into the distance, and pretend not to notice.

So why get indignant when health insurance companies, with malice toward none, try to make as much money as they can? Most of us just sigh, gaze into the distance, and pretend not to notice—because we know that's why they're in business, their raison d'etre. Their corporate destiny is to minimize risk and maximize profit, and they can no more control that instinct than your dog can leave the neighbor's tree unwetted. That means, if they can get by with it, declaring your whole body a pre-existing condition.

Well, then, I can hear you saying, why are the Clintons giving insurance companies such a large role in the reform plan? Why rely on entities you know are constitutionally more interested in better profits than in better health care?

And why, I hear you further saying, don't the Clintons just do an end run around the insurance companies and go for the single-payer plan where the government itself underwrites our health care?

"Tax it, pay it, and get it over with," proponents of such a plan say. Government bureaucracy is no worse than insurance company bureaucracy, and it's not driven by an institutionalized profit motive.

So why, you ask again, don't Bill and Hillary propose that?

I'll tell you.

Because they know the single-payer plan would goose us in our national logophobia about—dare I whisper the words in a family newspaper?—socialized medicine.

It's the same logophobia Sen. Phil Gramm tries to activate when he says "The President and his wife are very good salespeople but the bottom line is that they are trying to sell socialized medicine. . . .They cannot sell that to the American people."

And it's the same logophobia exhibited by an energetic and intelligent woman I know who's had a bellyful of health insurance dealings in the last decade. "I don't want socialized medicine," she says. "But we need something different than we have. We need Medicare for everyone."

It's logophobia because the fear is of the words themselves rather than of what they stand for. Ask most of us whether we favor socialized education, socialized highways, socialized ball parks and we get red in the face and say nosireebob, we like things the American way.

We might work through that phobia with enough word therapy: Say "socialized medicine." Now say it again without looking like you've just swallowed a toad. Now smile when you say it. Now say "socialized medicine, ALL RIGHT!"

And so forth.

But it might be easier just to change the words that scare us.

We might call it "subsidized medicine." Get sick and the government gives you a subsidy to pay the bills. Those rugged individualists who are most rabidly phobic about "socialized"—farmers, say, and right-wing industrialists, defense contractors, Texas senators—become quite agreeable when they hear "government" and "subsidy" in the same sentence.

But if the Clintons need even more support—universal assent for universal coverage—they might call it the "medically activated tax refund plan." Get sick, you get a tax refund to pay for it. If it costs more than your tax bill, you get a refund of taxes paid by someone who has the misfortune of staying healthy. Helluva deal.

Could anyone oppose that? Imagine the response to Sen. Gramm saying "The president and his wife are very good salespeople but the bottom line is that they are trying to sell a tax refund …They cannot sell that to the American people."



Satterfield is a college professor and writes as a means of discovery.

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