Report from the Future: Health Care in the Year 2024
By Richard E. Ralston
October 19, 2004
The Presidential Election in 2024 might hinge on the present
health care crisis, but none of the candidates have been able to
propose any solutions.
The band-aid since the last Democratic Administration (2016) has
been three increases in the “temporary” health care surtax on
households with incomes over $200,000 per year. The marginal tax
rate on these households has reached 90%. There is symmetry here as
this group now provides 90% of tax revenue, up from 35% twenty years
ago. I.R.S. officials are at a loss to explain why the incomes of
these taxpayers have been declining in recent years. Mandatory
health premiums for all Americans—including those who have opted
out—have therefore increased 30% each year.
The chief problem remains costs. These flattened out briefly in
2017 and 2018 when means testing was introduced and those with
incomes of $80,000 or more were removed from both Medicare and all
government health insurance programs. Rapid increases in cost
resumed by 2019.
The crisis accelerated after the nationwide, 8-month walkout by
the American Federation of Nurses and Health Care Workers in late
2019. The parallel strike by the larger Hospital Accounting Workers
Union resulted in a doubling of health care payroll costs. (Both
unions won an exemption from the income ceiling for eligibility for
government health insurance.) Public reaction swept the Republicans
back into the White House in the 2020 elections. President Bush has
not yet been successful in passing her cost control legislation. An
attempt was made with the creation of the National Waiting List Data
Base to increase the efficiency of establishing rationing for
surgery and special treatments. This was defeated when Bush refused
to exempt certain “politically correct” diseases. The pleas to
address the crisis of increasing death rates from delayed treatment
of heart conditions went unheeded. A compromise bill eliminating all
benefits for smokers was passed.
Americans are still free to opt out of the National Health
Equality Plan. But since government physicians were exempted from
liability, the average liability insurance premium for the few
remaining private care givers has risen to $600,000 per year for
physicians and $4,000,000 per year for surgeons. Private health care
is therefore an option only for extremely wealthy patients—mainly
from Europe and Asia. Litigation has dried up to the point that, in
desperation, the National Trial Lawyers Association is now lobbying
for the complete elimination of government health care in favor of
unrestricted laissez-faire medicine. This has precipitated the
greatest internal struggle in the Democratic Party since the Vietnam
War.
One bright spot has been the relatively modest increase in the
cost of prescription drugs since the failure of six of the top ten
American pharmaceutical companies. Europe and China now manufacture
90% of our prescription drugs. Since patents of American drug
companies were eliminated, foreign companies have dominated the
market. They were only held up by the need to wait for American
companies to first pay the high cost of obtaining FDA approval for
each new drug. The rapid decline in the introduction of more
expensive and revolutionary new drugs has helped. On the down side
is the explosion in the cost of vitamins since the FDA began
regulating them. A federal court recently ruled that the “right to
health care” requires new drugs (whose rare components are very
expensive to produce) to be provided to extend the sex lives of
those more than 100 years old—a bad sign for cost control in the
future.
President Bush maintains that her goal is to “save” the system.
Her opponent runs against his own Democrat platform. He caused a
major disruption during his acceptance speech when he said “We must
face up to the fact that the federal government has failed to
deliver adequate health care to the poor, even at the cost of
destroying it for everyone else.” Neither candidate has yet provided
specific remedies.
You can’t figure out whom to vote for? You can’t figure out how
the hell we got into this situation? You might want to look back at
a few previous elections.
Richard E. Ralston is Executive Director of Americans for Free Choice in Medicine.
Copyright © 2004 Americans for Free Choice in Medicine. All rights reserved.
For reprint permission, contact AFCM.
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