Health Care "Entitlement" Is The New "Death Tax"

You have to be at least a little amused by the way health care reform opponents are using the word “entitlement.” In their world, the word can’t be spoken without dripping sarcasm and derision. To them, the fact that an entitlement might be involved is reason enough for the health care reform effort to be stopped dead in its tracks.

This makes “entitlement” into this year’s version of “death tax,” the phrase that was used so successfully in the debate on estate taxes. Even though we don’t actually tax death, the phrase was effective because, while very few people have an estate of sufficient size to be taxed, everyone dies. As a result, support for a tax cut that would only really apply to a very small group grew to include many others.

The irony of entitlement becoming this year’s version of death tax is that the situation is the mirror image of the estate tax debate: only a handful of people pay estate taxes but virtually everyone in the U.S. benefits already personally benefits from one or more entitlements. This includes everyone from older Americans on Social Security and Medicare, to veterans who receive various benefits, to farmers getting agricultural price supports, to students and their families getting loans for college and graduate school, to corporations that get certain tax breaks, to banks that are entitled to borrow from the Federal Reserve.

But these are just the official entitlements, the ones that meet the technical legal definition of a program that provides benefits to anyone and everyone who meets the qualifications. For moral reasons, many other entitlements have become so commonplace in the U.S. that they are considered the equivalent of binding requirements.

The best example of this is the interstate highway system. When he was a senator from Alaska, self-professed fiscal conservative Ted Stevens used to demand that his state get federally subsidized air travel because weather and terrain made it impossible to build highways. Even though Alaskans make a choice to move to or stay in the state knowing the conditions, this supposed antigovernment spending Republican in effect said his constituents were “entitled” to have their transportation subsidized because we were doing it everywhere else.

Health care falls into the Ted Stevens/Alaskan highways category. Anyone who has ever been to a hospital emergency room, especially in a public hospital, knows that health care is already being provided to anyone who needs it regardless of whether they have insurance or can otherwise afford to pay for it. In some cases this is mandated by law. In others it’s simply become common practice. But regardless of the reason, in the same way that we don’t actually tax death, health care already is at least a moral and ethical entitlement in the United States and has been for quite some time.

If you have ever been in an emergency room, you also know that the health care provided there to those who don’t have any other way to get it is also about the worst and most expensive way to make it happen. My doctor tells me that it may cost five hundred dollars or more just to check in a patient let alone actually treat them. We are all already paying for that treatment with higher prices, larger insurance premiums, and increased taxes.

So in spite of what anyone tries to say differently about the health care debate, in the same way that death has never been taxed, no one is actually talking about setting up a new entitlement. The only thing being discussed is how the health care version of the Alaskan highways should be provided and paid.