Paying for Doctors and the Unemployed

On America Magazine today, there is a discussion about a Washington Post article from over the weekend about a permanent fix for the payment of primary care physicians. Of late, their has been a group of libertarian dissenters responding to Michael Sean Winters. More than often, I come to MSW's defense. You can see the debate at http://www.americamagazine.org/blog/entry.cfm?blog_id=2&entry_id=3023&comment=1&success=1 and see the original story at http://www.washingtonpost.com/wp-dyn/content/article/2010/06/18/AR2010061804700.html. I responded to the knee jerk libertarians, who relied on the American concept of rights rather than the positive rights recognized by the Church - and then related the whole thing to the abortion question. I then offerred a solution to the canundrum of the "Doc Fix" as well as the ultimate fix for other problems in both Medicaid and Unemployment Insurance. Here is what I said:

...the right to health care that MSW was referring to was not one found in the constitution but in Catholic doctrine. Not all considerations of what people are entitled to need to be referenced in American ideals of liberty. The Magisterium of the Catholic Church states that there are positive rights that people are entitled to, regardless of what their governments declare, and among these are health care and a fair living wage (meaning that families need to earn enough to survive and larger families deserve greater consideration). To the extent that political or economic libertarianism is inconsistent with this teaching is the extent that Catholics must ignore their politics and support doctrine. This is also true in abortion - however in all cases, it is best left to the Catholic politicans to say how this is best done. Note that the Social Security system was designed in consultation with a Jesuit priest based on Catholic social encyclicals (Fr. Ryan). I would argue that living wage legislation is the best way to solve both our economic obligations and our obligation to protect the lives of the unborn (just as providing low cost or mandatory rehab is a better way to fight alcoholism than prohibition).

On the subject of paying for care - paying for a doctor fix, the medical needs of the baby boomers, the need to provide affordable medical coverage to people on COBRA and the need to provide for extended unemployment insurance all have a ready made answer, although many will find it distateful. These are all from funds that were designed to be self-supporting originally. Expansions of these programs or merely making them cost effective must ultimately be funded by raising their dedicated revenue streams - however we need not do so in advance of need. We can drop the requirement that the Medicare trust fund maintain some type of long term balance that must be pre-funded. It would be better to allow the tax rate to be raised automatically than to mandate budget cuts instead - or perhaps we can mandate a mix of both unless Congress acts.

In the short term, deficit finance is necessary - however in the long term, subsidizing COBRA, funding doctor fees adequately, providing for longer term unemployment and for Medicare Part D is best done with payroll tax hikes. Indeed, in the area of unemployment - a higher tax rate may have employers think again before assuming that laying people off is in their best interests. The whole point of the tax was to add a little bit of pain to the decision to reduce payrolls to save money. Perhaps this is just the time to make that pain increase.