Rick Perry and the GOP can keep Texas out of the Affordable Care Act (ACA) Medicaid expansion or a “Lloyds”-type exchange-type market in insurance policies as an act of ideological zeal, spite, or ignorance.
But, Houston will pay a heavy price mostly in the form of higher local taxes of every sort — other than income taxes. Income tax revenue will fall because health care professionals will be providing less care and simply moving elsewhere. So, how is that a good thing?
The GOP is very clear on the point that the US has “the finest health care system in the world”. Well, in some respects, yes. And, Houston is better still in some respects.
However, such jingoism may reflect little more than the extraordinarily high income of some hospital-based specialty physicians. If you are one of those, fine.
But, in Houston, the impression of quality is also heightened by marketing hospital services as a luxury good worldwide and by cultivating both private and public finance for prestigious medical research and education. Such research, education, and treatment are provided in spectacular buildings. So, there are construction, finance, and professional architecture and engineering services as well.
There is even a boom in government-guaranteed, multi-layered financial instruments for “nano-bio-info-enertech” deals complete with California-style gossip and scandals.
“Healthcare” is an oxymoron:
Public and Personal Health + Medical and Allied Personal Care
They are very different and complex.
They are not mainly luxury goods or pure public goods like, say, national defense. They probably cannot be financed by strictly private wealth or strictly government appropriations. Capitalism versus Socialism is not a useful way to discuss any of this.
Our public and personal medical and allied plant and professions will be financed by complex markets that are mostly privately regulated but increasingly government subsidized as the population ages. So, where is the GOP taking us with their mix of free-market utopia and bad-government dystopia?
While preaching austerity elsewhere, the GOP is taking Houston deeper and deeper into at least two overlapping, debt-driven booms.
But, we are a great port-city and cannot secede from the world economy. We need any of several varieties of reform in medical indemnity insurance and medical, surgical, dental, psychiatric, and other forms of personal care in order to compete effectively around the world. That is especially in labor-embedded technical services where we support a huge, expatriate workforce.
And, when it comes to microbes, this is a very dangerous world we live in: It is one where there is no “castle defense” from public health menaces. Actually, castles were disease amplifiers in their day, sort of like unregulated day-care centers here and now.
Both the ACA itself, as well as the Medicaid extensions and, possibly, the opt-out alternatives provided by the President are what it will take to keep our local taxes and out-of-pocket expenses from rising, well, like sea levels, maybe catastrophically.
What Governor Perry is doing then or, at least, grandstanding over forces our institutions to compete in national and world markets from further and further out on the fringe, indeed, from out on a borrowed-money limb.
We already have one nearly bankrupt medical school and a see-through hospital in the Texas Medical Center. This is no time to entrust what we have and will need to an Aggie “yell leader” or a clueless but wealthy elitist from Massachusetts.
Democrats in Harris County are “Making Lives Better for All, Not Just a Privileged Few”. That takes a lot of patience and proficiency – like most cures.