Politics is the art of the possible. But it’s also the art of possibly making things better! So I do think it’s worth spending at least some time thinking about unrealistic and utopian plans. But this is rarely done. I do, however, find myself drawn to Brad DeLong’s Unrealistic, Impractical, Utopian Plan. To summarize its key elements:
— 1. Taxes on public health hazards (booze, sweeteners, etc.)
— 2. An army of publicly employed doctors and nurses working in clinics and vans and such roaming the country dispensing preventive care and lifestyle advice to all and sundry.
— 3. 15 percent of your income is automatically plunked into a Health Savings Account.
— 4. When you want health care services that aren’t covered by the clinics, you pay out of your HSA.
— 5. If there’s money left in your HSA at the end of the year, it gets plunked into your IRA unless you specifically fill in an opt-out form.
— 6. If you run out of money in your HSA and need more health care, the government pays for it.
— 7. On top of the 15 percent HSA deduction, there’s a 5 percent tax to pay for 6.
Because the cost-sharing is all tied to shares of income, the overall impact of this would be strongly progressive. Better-off Americans will in effect be paying for a lot of their care out of pocket (via their HSA) while poor Americans will mostly be on the dole. But nobody will ever have any financial reason to forego the basics of preventive medicine, and nobody will ever need to worry about going bankrupt over medical expenses.