Tuesday, December 26, 2006


More about Universal Health Care

Today (St. Stephen's Day, 2006) blogger and writer Ezra Klein writes in the Los Angeles Times that the days of our present broken health care system are numbered. The present system is based on providing subsidized health insurance as a perquisite of employment. Employers are beginning to abandon the system because of the rapidly increasing cost of health insurance.

What are the alternatives? Klein lists two models:
  1. Extend Medicare to provide coverage for every American. Congressman Pete Stark of California favors this approach.
  2. Establish a legal requirement for every person to buy health insurance and require insurance companies to provide plans at reasonable cost. This is the essence of the Massachusetts plan. In addition, Massachusetts provides financial assistance to low income residents who otherwise can not afford health insurance.

Both of these models are institutions that are currently in operation. Medicare has existed since the mid 1960's. The public knows how it operates. It is a popular program. It's good, if not perfect. The Massachusetts plan has only recently begun to operate. It is too early to assess its performance and popularity with the public. I have written elsewhere that I regard the Massachusetts plan as something like a band-aid applied to our existing broken system. It has the advantage or disadvantage, depending on your point of view, of keeping the private insurance industry in the profitable business of supplying health insurance to healthy, young people.

Mr. Klein has a critical view of a plan put forward by the private insurers:

The most compelling evidence that resistance to reform is futile, however, is
coming from the insurers themselves. Cognizant that Congress and the nation are
tiring of the current dystopia, the insurance industry recently released its own
plan for universal healthcare.It's a bad plan, to be sure. Its purpose is more
to preserve the insurance industry's profits than improve healthcare in this
country. But the endorsement of universality as a moral imperative, and the
attempt to get in front of the coming efforts at reform, mark the emergence of a
distinct rear-guard mentality within the insurance industry. Their game is up,
and they're turning some of their attention to shaping their future rather than
betting that they can continue protecting their present.

Mr. Klein mentions three elected officials who propose to support changes in our present health care mess. Pete Stark, a Representative from California and probably the new Chairman of the Health Subcommittee, favors a "Medicare for all" solution. Senator Ron Wyden of Oregon has assembled a coalition of "union leaders and corporate chief executives" to put together a plan similar to the Massachusetts plan that would rely on existing private insurance companies to provide health insurance. Governor Arnold Schwarzenegger of California recently vetoed a bill passed by the State Legislature that would have established universal health insurance as the plan for California. However, he now says that he wants to work with the Legislature and others to create a universal health care plan for the State.

Mr. Klein sees the acceptance of the failure of the present system as a hopeful sign. There is recognition of the need for health care to be universally available to all regardless of income. One way or another, he feels, we will find our way to something that is better than what we now have. It will be better in that it will be less expensive and will provide better care for everyone. We Americans spend more per person on health care than any other nation on earth, but the results of our system measured in life expectancy and infant mortality are rather poor in comparison with the results in other industrial nations.

I am not as optimistic as Mr. Klein. Big Pharma and big Insurance are too big and too profitable to succumb without a terrific struggle. We saw what they could do in 1994 when they defeated President Clinton's attempt to achieve universal health care. It may be that, for the time being, we will have to be content with a plan like that of Massachusetts that keeps big Pharma and big Insurance as profitable entities. Governor Schwarzenegger, for example, has slhown his disdain for the Medicare or the Canadian models because they both involve a change of funding from private insurance premiums to public taxes. The fact that most individuals will have actually less out-of-pocket expenses under a Medicare or Canadian type of system than at present doesn't convince either him or his hard-line Republican allies that the change should be accepted.

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