To the Editor:

Friends, who nevertheless enjoy seeing me squirm, have challenged me to propose a way to solve the problems of public welfare. Accordingly, since I am not an expert, the nature of this suggestion, and any others I may propose, will be the caliber of those that heatedly pass around the table when retired men gather on early mornings over coffee for the opportunity to playfully harangue each other while collaterally solving world problems.

I recognize that proposing a solution will obviously not be as easy as it was, when earlier I blithely recommended reducing welfare. I also know that when considering a solution it soon becomes obvious that solving welfare problems first requires a solution for health care.

Both the illnesses we encounter and their expenses are unpredictable. This is the attraction of medical insurance; a catastrophic illness can bankrupt any but the wealthiest. Thus, medical insurance is the inventive vehicle that allows individuals and families to jointly assume and average the cost of medical expenses, while unintentionally enriching insurance companies and their executives.

Medical insurance for our society is not a practical health care solution. First, there is an enlarging portion of our society unable to afford any health insurance; and second, those that have medical insurance are inclined to squander it. This is best envisioned as a buffet where once entitlement has been established, diners freely load their plate beyond need and beyond what they intend to consume. It should also be envisioned as a so-called free bar where bartenders (representing doctors) encourage consumption to improve their bottom line.

Whether well off or poor, we all need medical intervention. The very poor, aggravated by their poverty, need it more often. But because of their poverty, they are unable to afford even ordinary medical expenses. Being unable to afford treatment, however, will not prevent them from continuing to incur expenses; this is unavoidable and it is equally unavoidable that someone else will have to pay those expenses.

This payment will likely be through government intervention in which society will share the expense through higher taxes or, alternatively, the medical community will provide the service and again pass on the expense to society by billing higher amounts to those individuals and insurances able to pay.

If we are to formulate a solution, we must first concede that everyone, regardless of ability to pay (think of the children of poverty), has to have medical help when needed; with this acknowledged, we may proceed toward a solution. We should also expect that the solution’s cost (like medical insurance) will be apportioned to society.

Suppose we conceive of a model where restraint and prudence are guardians, deliberately enlisted to ensure the reduction of the high cost of health care. Group endeavors are most successful when individuals, freely acting in their own selfish interests, unintentionally support group goals.

Suppose that instead of a government solution that provides universal health care, we instead provide an allotment of medical care. Suppose that every adult individual were to be immediately invested with a medical account of say $15,000 with annual allotments of say $2,500 and a smaller annual allotment for each child.

These particular dollar amounts are hypothetical; actuaries in collaboration with politicians (heaven help us) could establish the actual amounts. Their basis would be slightly less than the already known per capita costs of state provided insurance and later fine tuned (reduced) based upon actual costs.

The specific rules would be that each individual’s account would be vested with that individual for their lifetime and accumulate without limitation. Individuals could freely charge against their own account until it is exhausted or could carefully shepherd their account and allow it to accumulate. Because self-interest is so heavily involved, unnecessary and redundant medical care is likely to be avoided.

Since those presently able to afford private medical insurance might want to continue their enrollment, they should be allowed to, and they should be allowed to use their medical account to pay its cost. Or they could negotiate for a catastrophic and less costly private insurance based upon all their medical expenses being first paid from their medical account.

Non-profit charitable organizations, without charge (that’s why they’re designated non-profit), could and should advocate for the uninformed and recommend economical sources for medical treatment. Since individuals would, in essence, be paying with their own money, and frugally doing so, medical providers would likely become competitive, thereby further reducing medical expenses.

There will still be instances where an individual’s medical account is exhausted and their expenses continue to accumulate. It is at this point that the government should no longer be responsible. If there are still medical needs, then charitable organizations could consider interceding. This could and should be similar to someone in need of a transplant who cannot expect government intervention, but instead is dependent upon a charitable donor.

There are additional rules that could cover the disbursement of the medical account. Parents could and would be expected to spend from theirs for their minor children, but not vice versa. Adults could donate individually or in groups from their own account to anyone whose account is exhausted. Upon an account holder’s death, one half their account’s value could be willed just as any other property to a qualifying individual or to a charitable organization, which could further contribute to those account holders whose own accounts have been exhausted and the remaining half of the medical account, reclaimed by the state.

Theoretically solving the health care problem still leaves unanswered exactly how it is to be actually implemented. If a state such as Maine were to implement this, then multitudes of uninsurable individuals would migrate here primarily for the coverage and make the system unworkable. Unfortunately, federal regulations would likely prohibit limiting membership solely to current Maine residents.

In adopting an idea of this magnitude, it would be wise to first test it on a random population of limited size. A federal waiver for a statewide restricted plan would be required or perhaps even for a federally funded social laboratory plan limiting membership by a truly random qualification, based upon the last two social security digits of the head-of-household.

If the plan is initially seen as effective, membership could be gradually increased.

Dick Sabine

Lewiston