I took advantage of spring break to hear President Obama give his last-ditch speech arguing for an up-or-down vote on health care. The Republican response by Mike Pence was so predictable I doubt he had even heard Obama. Obama’s plan, he said, following a long and unvarying line of Republican talking points, amounts to a government takeover of one-sixth of the nation’s economy.
Pence wasn’t thinking, but he made me think. If we really did have a government takeover of health care, I wondered, what would that look like here in Billings? Let’s see: We have two hospitals, both nonprofit, one owned by a religious order. Because of their nonprofit status, they don’t pay property taxes that support public services like police and fire protection, street repair, and public parks. In return, they write off tens of thousands of dollars every year in bad debt from sick people who can’t pay their bills. They draw funding from an astonishing array of sources: tax deductible private donations, government grants, Medicaid and Medicare reimbursements, CHIP, private insurance, government-provided insurance for public employees, etc. They provide emergency services to people who need them, whether those people can pay or not. Those costs are absorbed by the hospitals, or passed along to other patients through increased fees.
Besides the hospitals, we have the RiverStone Clinic, which is owned by the county and city governments. We have a Veterans Administration Clinic that is owned by the federal government. We have a state health department that conducts all sorts of inspections, gives out public health warnings, etc. We have an ambulance service that operates under a government-awarded contract. And we have doctors in private practice, many of them educated at publicly owned or tax-supported medical schools, who cobble together their own methods of payment from various public and private sources.
So here’s my question: If Obama marched into Billings and took over health care, would we be able to tell the difference?