MTA Testimony on
SJR 8 - "HEALTH CARE FOR ALL MARYLANDERS"
February 12, 2001

MARYLAND TAXPAYERS ASSOCIATION URGES
AMENDMENTS TO SJR 8
ALLOWING OPEN, BALANCED, AND PARTICIPATORY CONSIDERATION OF ALL HEALTH-FINANCING ALTERNATIVES INCLUDING CONSUMER CHOICE AND FREE-MARKET SOLUTIONS

Statement of MTA vice president Richard Falknor, and
MTA Board Member and physician Christopher Unger, M.D.
before Maryland Senate Finance Committee,
February 15, 2001 at 2 PM.

Chairman Bromwell and members of the committee, I am Richard Falknor, vice president of the Maryland Taxpayers Association, and am accompanied by our Board member, physician Christopher Unger, who practices in Bethesda and who has long experience in health policy both as an individual practitioner and as an aware citizen.

Apart from the general interest of MTA's membership in free-market and consumer-choice solutions to improving Maryland life, from schools to health-care, MTA has a particular concern over the likely tax implications of the well-known Maryland Citizens' Health Initiative single-payer plan. Here is an excerpt from the scholarly Lewin report (www.healthcareforall.com/Lewincov.htm) commissioned by MCHI themselves:

"The remainder of the program would be financed with new taxes created specifically for the program. In addition, there would be changes in personal income tax revenues as wage levels adjust in response to the payroll tax imposed on employers under the program. Total net tax revenues would be about $9.5 billion in 1998. These tax revenues include: * Payroll Tax - The program imposes a payroll tax on employers and employees in Maryland. The tax rates in the first year of the program would be 6.3 percent for employers and 3.2 percent for employees . . . " [emphasis MTA's]

What we ask is that any Maryland commission you authorize to put its imprimatur on a plan providing "Health Care for All Marylanders" be open, balanced, and participatory. These tests should also control the regional 'town meetings' authorized and directed by SJR 8 in its current form. Indeed MTA supports regional 'town meetings' that allow our citizens to see exactly how the current Maryland health-financing and health-regulatory system works and to understand the clinical and financial benefits and costs of competing proposals.

The kind of deliberations and citizen participation we propose, however, simply will not happen without the safeguards we propose. We cannot have a Panel on Comprehensive Health Care whose guiding members and likely staff are steeped solely in the culture of government-directed medicine. Alternative and challenging expert and citizen views are unlikely to be sought, to be understood, to be presented at regional meetings, to be noted and recorded, or to be included in final recommendations.

Consequently we make these proposals to refine and perfect SJR 8:

On the structure of the Panel, we recommend a general simplification. If there ever was a political, not a technical decision, it is recommending a "Health Care Plan for All Marylanders." 'Experts should be on tap, not on top,' is an old but sensible maxim of public administration. In our view the Panel should be composed of nine members, appointed by the Speaker of the House of Delegates, the President of the Senate, and the Governor, with at least four of the nine members drawn from elected state or local officials of the minority party. The Panel should choose its own chair, and the majority and minority should each have their own staff and equitable shares of Panel funds to call experts, to commission studies, and so forth. Only through policy competition can we ensure that all points of view are available to the public and are considered. The Panel should also be governed by Maryland Public Information Act and parallel statutes so that it truly deliberates and gathers information in the sunshine.

On the reach of the Panel's study, we would expect the Panel:

  • To examine the costs of mandated benefits in Maryland, including the additional cost in insurance premiums for individuals and families as well as the impact of cost increases on un-insurance. Maryland leads the nation in the number and scope of benefit mandates. There is no serious argument among professional economists that there is a direct relationship between rising insurance costs, the affordability of insurance policies and the level of un-insurance. The Commission should explore the impact of this problem and seek the testimony of experts on the number of the uninsured.
  • To examine the nature and the impact of Maryland's insurance regulations, and the impact of those regulations on the provision and access to health insurance in the state of Maryland and the kinds of benefits packages that are available to Maryland citizens.
  • To examine the regulatory system that governs providers, including Maryland's system of hospital-rate regulation, the remaining features of the certificate of need rules, and the ways in which the current regulatory system affects doctors, hospitals and the quality of care given to Maryland patients.
  • To address the issue of patient privacy. Maryland patients should be confident that the information that they provide their personal physicians in a clinical setting is confidential and cannot be disclosed without their full, voluntary and informed consent.
  • Tto examine the tax treatment of health insurance, and the impact of the tax treatment of health insurance on the availability, affordability and portability of health care benefits packages.

Citizens and legislators can get additional facts and analyses from our website www.mdtaxes.org under the rubric "Consumer Choice in Health."

Thank you, Mr. Bromwell and members of the committee, for hearing our recommendations.

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