I worked for the state government for 10 years, in various capacities. Before that, I interned in my congressman's office. And in both places, I paid special attention to any health care stuff that was going on. The first budget I worked on in the Senate, I had the good fortune to meet an excellent lobbyist (yes, they exist) who fought to keep the state's Bureau for Children With Medical Handicaps (BCMH) funding alive in what was a very, very, very tight budget.

The State of Ohio has to have a balanced budget. We can't run a deficit. So we can't pass a budget that doesn't add up, and that means that, as great as many programs are, we can't keep them all if the funding isn't there. Fortunately, BCMH was saved, because BCMH works with many families with kids and adults with chronic diseases, like CF. We never had to use BCMH funds, but I know that they were, and are, extremely useful to families who need money to help pay for treatment, equipment, and care. It's a nice safety net and really makes a difference to a lot of families.  

(To me, this is an important part of the pro-life ethos: helping families and adults who have chronic conditions receive good care for said conditions. That's what BCMH does. And right now, in Ohio, they're talking about cutting it again, which irritates me, because it's a program that does a lot of good for small(ish) output. So, back to the crusading we go!)   

Now, like I said, Ohio has to have a balanced budget. The federal government does not.  Hence the "debt clock"    .  (There have been various efforts at a "balanced budget amendment" over the years. Hasn't happened yet.) But that doesn't mean that the government can just make stuff happen--poof! Magic! Being $19 trillion in debt is probably not the best economic policy. And when there isn't enough money, you run into issues like the one we currently have with Social Security--it's not going to be solvent forever. At some point, all the bills come due. 

If you work for a particular member of Congress or the state legislature, you get lots of phone calls, emails, and letters. Most of these involve wanting the government to do something--and that something usually involves money. Any time you hear the word "free" come out of a politician's mouth, you should laugh. NOTHING is free. Someone is always paying for it. Now, that someone might not be you. But someone is. 

"Free" health care. "Free" college. "Free" preschool. "Free" whatever whatever whatever. 

Someone, somewhere, is paying for that. Let's not debate the ins and outs of whether or not these people should, or types of taxation. Let's just all agree that somewhere, someone is paying for all the "free" things. "No such thing as a free lunch" also applies to everything else. 

*     *     *

One of the things that makes America different from other countries is federalism. (Federalism--the divide of power between state, local, and federal government.) That idea is enshrined in the Constitution and it's something that also makes life....hard, when it comes to spending. 

There is always an underlying argument about the powers of the federal government and what the federal government should do. Really strict interpreters of the Constitution say that the federal government should only do the things listed in Article I, section 8, which includes things like: 

• Maintaining "post roads"--we could probably say road maintenance today. Highways, especially, since they're interstate. 
• Borrowing money
• Regulating foreign trade
• Creating and regulating the lower court system  (as in, everything other than SCOTUS). 
• Declare war, and maintain/provide for the armed forces--there is quite a bit about this in section 8.

(Like it or not, national defense has always been something the federal government has been charged to do. It's a big part of the Constitution. "Provide for the common defense" is part of the preamble. We can argue about what "maintain" means, in concrete terms. But it IS one of the few direct things the government is charged with doing. Ergo, military spending belongs in the federal budget.) 

Now, we can argue all day about what the government should provide for its people--and there are some things the government, at the federal level, just does better. The military comes immediately to mind, as does anything to do with foreign trade and foreign governments. We need a Secretary of State and a Secretary of Defense and a  Secretary of the Treasury. Those are important Cabinet positions that do important work. 

If we, as citizens, want the government to provide something, we have to determine what we would like them to cut in order to pay for something else.  We cannot have everything, it just doesn't work. Everyone who's ever had to balance a checkbook knows this--or any kid who got an allowance. You have $10. You can buy the books, or the My Little Ponies. But not both. (Childhood examples, right there.) 

So, if we want a minimum floor of health care that the government provides--what are we willing to lose? Sesame Street funding? The calls for universal Pre-K? Head Start? Highway maintenance? Disease research? National parks? Foreign aid? Humanities spending? Public health stuff? 

No one wants to be the politician to say "we cannot afford everything", because that politician will lose in his next election. But it's true. We really cannot afford everything. It's just not possible. 

*     *     *

What if we revamped the ACA so it was more like a safety net of health care? 

And by "safety net of health care", we could say: vision. Dental. Basic medical care: primary care guys, basic surgery, urgent care/ER stuff. Maybe specialists and certain types of special care (chemo? etc.) Not Viagra. (Sorry, guys.) Not birth control. (Sorry, ladies!) Not cosmetic surgery, etc. But things that actually are vital to health. To keeping you alive, or fix big issues, like eyesight or hearing, that can really improve people's lives.  

Again, this would be nice. The question is: how do we administer it? How do we make it happen? How do we codify it? (Get it into law) And above all, how do we make it effective, so people aren't waiting years and years to get things they need?  

The easiest thing, in my mind, would be to just call a spade a spade and say it's a tax. It just is, like Social Security. You just pay it. It gets taken out of your paycheck. Stop it with this whole "you have to buy insurance but it's not a tax" thing. It is. It's a tax. Just call it what it is. Say that we're going to have a certain bedrock level of care that's going to be low-cost because everyone is paying for it. 

We do have to get rid of the connection between employment and health insurance. And we have to get rid of the inability for people with actual health problems to get said health insurance, because we're the ones who need it. We also need to fix Social Security Disability so that states cannot deprive certain populations in their states from being eligible for SSDI. 

But all of this is insanely complicated to codify, especially since we have 50 different state laws regarding health insurance mandates and what needs to be covered. The national law generally overrides state law--so while Colorado has "legal" marijuana, technically that's against federal law, and if the feds wanted, they could prosecute the state of Colorado. But, for example, Ohio can ask insurance companies to cover blood sugar monitors for diabetics, but Illinois could say, "nah, we're not going to require that." 

So really, in my mind, we need to get rid of the employment thing first, and cover people who need covered. That has to happen. Then we can talk about what else we want. 

Because American health care--as in, actual care--is quite good. I'm alive because of it. We do lots of crazy things here that are awesome, groundbreaking things. 

What is not awesome is the insurance system. It is, to be kind, a bit insane. 

"Politics is choosing," some one in some political movie said. (I think it was The American President.) We have to choose. What do we want our government to do? What is our government's job? And then go from there--but realizing that nothing is free, and that if we want something, we have to be willing to give up something else.  What are we willing to give up?