Are Local “Health Districts” An Answer to Universal Health Care Delivery?

[Tim Liston]

Though I tend to be branded a conservative, I break from garden-variety conservatism in some ways. One being that I’m more or less for some form of universal health care coverage. Why? Partly because we already have it. Nobody is left to die on the street for want of treatment, all he/she has to do is go to the emergency room and he/she must legally be treated for any affliction, big or small. So much for the myth that we don’t yet have universal health care. We do….

But this ad hoc form of “universal health care” is obviously very inefficient in many ways. So let’s say we adopted universal health care “for real.” Here’s one way it could be implemented….

First, government could define “Health Districts” that roughly correspond to municipalities. Lakewood, as a medium-sized city, would comprise a medium-sized Health District. Cleveland would be large, perhaps with several neighborhood provider facilities. Smaller, contiguous cities could combine themselves into a single Health District, e.g. Pepper Pike, Moreland Hills and Hunting Valley sharing a single facility.

Every such Health District would be staffed by government-employed health care providers who would be paid by way of a series of taxes imposed primarily on residents of their particular Health District, though some modest funds could come from state and federal sources. Tax money would go directly to the provider, not first to the health care recipient.

Now here’s the thing. If/when you get sick, you would be permitted to utilize ONLY the services of your local Health District, e.g. the “Lakewood City Health District.” You could NOT use the services of another nearby District, no matter how poor the outcomes and staff in your local Health District. You could utilize one of the “private” health care providers that would inevitably become available, they wouldn’t stop you. But you would have to foot the entirety of the enormous cost yourself, probably $20,000 a year or more. And you would still have to pay the taxes to fund your local District.

Sure, that’s one way to deliver universal health care, but it seems to me that being confined to your local Health District, and further assigned to a (“tenured”?) government doctor within that district, regardless of quality, would REALLY SUCK. It seems to me that creating “monopoly” Health Districts would suppress competitiveness. It seems to me that such a delivery structure for government-provided health care services would inevitably poorly serve those in need of such services relative to other potential delivery options. Does it seem that way to you?

Then why do we eagerly embrace the same structure for delivering K-12 public education? I’d bet that if we implemented universal health care by way of “Health Districts” in the same fashion as today’s School Districts, there would be rioting. The same as if we likewise established government-protected Grocery Districts that eliminated 95% of your food choices. (You can’t shop at Heinen’s. You’re assigned to Sapell’s. WHAT?)

The fact is, if we really want to improve the quality of K-12 education, we need to first and foremost eliminate all School Districts and let each traditional public school become a public charter. Then, second, we need to fund the families and not the schools, and let each family choose the schools that best suit its children. The way we now have a wide range of medical options. Families with special-needs children could receive additional funds for special (and presumably more expensive) programs. Just like they do now, but with the dollars going to the family first, not directly and only to the mandated school.

We need to break down the monopoly each School District has on its local residents, and make schools compete for educational dollars. Not let them sit back and collect those dollars regardless of effort and outcomes. Sort of like what happens in the real world. It wouldn’t take long before educational outcomes improve dramatically, and we are no longer neck-and-neck with Paraguay and Bulgaria for educational achievement.

BTW I’m not holding out our health care delivery system as a model of efficiency. Far from it. But public education is far worse and badly in need of an overhaul. Of course the government schools fight this tooth and nail. “For the children” I suppose….