Sunday, March 04, 2007


Universal Health Care and Public Opinion

A few days ago I read several "letters to the editor" of the Los Angeles Times regarding a proposal to establish a "single payer" system to provide health insurance to all residents of California. A proposal to do that was passed last year by the State Legislature, but Governor Schwarzenegger vetoed it. He said he opposed a state-run health care system. The Governor is a Republican.

I have expressed elsewhere my own objections to the "universal" health insurance scheme that the Governor advocates. What interested me in the "letters" that I read was the lack of public agreement on any one plan to solve the health care problem. One writer expressed support to the single-payer plan supported by State Senator Sheila Kuehl. Another writer proposed that private insurers could do a better job than government in providing a fair and adequate system of health care for everyone. Together, the letters (there were four of them, three expressing opposition to Senator Kuehl's proposal) convinced me that those of us, myself included, who believe that the Canadian single-payer plan is superior to the hodge-podge that we have here in the United States, have to conduct an effective campaign to educate and persuade the public that "single payer" is superior to "private insurers." We can not achieve a "single payer" plan by a mere majority in the State Legislature or by a mere majority of voters in a referendum. The support for the plan must be overwhelming. If it is adopted, it will be by consensus, not by a majority.

I think we have to make the following points:
  1. The single-payer system is not a "government run" health care system, like the National Health Service of England and some other European countries. Medical providers, doctors, hospitals, and clinics, would operate as they do now. All single payer does is provide health insurance to the entire population of the State at a uniform premium. Risks are shared among a large group. Physical examinations are not required to obtain health insurance under a single payer plan.
  2. Health insurance companies can not provide insurance to a portion of the State's population at a uniform rate unless the insured are in a pool in which there is a mixture of healthy and unhealthy individuals. That's why a large company can buy insurance for its employees at a cheaper rate than individuals. To stay in business, insurance companies must try to insure the healthiest individuals at attractive premiums and must charge unhealthy or risky individuals at risk for expensive medical problems high premiums.
  3. Developing a plan for funding the single-payer plan will be difficult. The logical and simple way is to let the State appropriate the "premium" money for the State's residents. The actuaries of the single-payer plan will calculate the proper amount for the premium in the same way that insurance company actuaries do now. This plan would entail an increase in taxes, in particular the State Income tax. The increase in taxes would be offset by the premiums that individuals and companies would no longer pay for private insurance. However, the State constitution decrees that any tax increase must be enacted by a 2/3 vote of each house of the State Legislature. Legislators who support the interests of private insurance companies would block the tax increase for the single-payer plan. Another funding plan is to let each individual pay a fee to enroll in the single-payer plan. That fee would be set by the individual's income, not his or her state of health or age. Companies that now provide subsidized health insurance for their employees would continue to do so, but would pay premiums or "fees" to the single-payer plan. The political advantage of using "fees" rather than "taxes" to fund the program is that fees could be enacted by a majority vote in the Legislature.
  4. The Single-payer plan must be a monopoly. If private insurers are allowed to compete, they will simply recruit the young and healthy residents of the State and charge them very low premiums. The Single-payer plan would be left with the task of insuring the old and the less healthy. The high cost of the plan would eventually turn public support away and the plan would be abandoned.
  5. A point that we must make, over and over, is that the present plan in the United States, such as it is, is the most expensive in the entire world. We spend more per person on health care than any other industrial nation in the world. Our life expectancy is shorter than that of many industrial nations that have some form of universal health care.

The public understands that our present health care system doesn't work well. We must take advantage of that understanding to get our message out and win public support. We don't have the luxury of waiting. There are other plans afoot that involve keeping the present system of competing private health insurers. Examples are the plan put into effect in Massachusetts and proposed for California by Governor Schwarzenegger. Let us be up and doing!

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