07 March 2006

Universal Health Care

I've been seeing a lot of buzz building in the blogosphere about universal health care as the best and possibly only solution for our broken health care system. It's heartening, because I have been a strident advocate for some sort of universal coverage for quite some time now. I don't know what sparked the conversation, but I'm glad to see it happening. Maybe it was Krugman's excellent piece at the New York Book Review, or Kevin Drum over at Washington Monthly. But the domino effect took hold and within a couple of days we were seeing Greg Anrig at TPM Cafe and Ezra Klein, followed by Kate at Healthy Policy and Matt Yglesias pile on the bandwagon. (Not that any of these folks are newcomers to the church of Universal Health -- but they were all talking about it at once.) They debate single payer vs multiple payers, incremental vs comprehensive reform, political strategy and obstacles to overcome, political risks and opportunities, oh my. Heady times. Add to that the fact that Massachusetts just approved a modest reform of its health plan, and you could almost deceive yourself into thinking that maybe there is a little momentum building, that just possibly, if people keep talking about this and the publicity builds, and maybe we've got a real thing here.

Then reality reasserts itself and you realize that with the current party controlling the federal government, there's no chance.

For that matter, the Democrats have't been forward on this issue either. As has been pointed out in many places, they are still in shock over the ugly demise of HillaryCare twelve years ago, and I cannot think of a single national-stature democrat who has advocated for this policy. I think its time is coming, maybe not yet as policy enacted into law, but as a hell of a political wedge issue. There are a lot of folks out there with growing anxiety about the cost and durability of their health care coverage, and a lot of folks with none at all. This is the Democrats' answer to the right's relentless drumbeat of tax cuts tax cuts tax cuts. . .

And Universal Health is the right thing for America, on many levels:

  • It's better for our economy because it would be more efficient and reduce wasted healthcare dollars - up to 3 percent of the GDP.
  • It would make American businesses more competitive in the international market by reducing the staggering health care costs employers have to pay.
  • It would provide American workers the ability to switch jobs without risking losing essential health care coverage.
  • It would remedy the logical non sequitur that your healthcare depends on your employment status.
  • It would strengthen the economy by improving the health of many marginal individuals and allow them to return to the workforce.
  • It would end the cost-shifting that doctors and hospitals have to go through to offset the costs of uncompensated care, and would increase the fairness of the pricing system.
  • Most importantly, it's a moral necessity to ensure all our citizens have access to medical care and to eliminate the underclass 40-to-90 million strong who are un- or under-insured.

I think this has to be the Democrats' core issue if they are ever to have any chance of being allowed back into power by the voters. We have to prove that there is something that we care about and are willing to fight for through several election cycles. This issue is not going to go away. The costs of healthcare continue to rise and the pressure on industry to contain expenses will rise in lockstep, and as they do, the number of uninsured will continue to soar and the expenses for medicaid will also climb. The medical system is in crisis, and until a solution is implemented it is going to continue to get worse. And it will represent a huge opportunity for the Democrats to prove that we deserve the reins of government. If we do nothing, the cost in lost opportunity and in human suffering will be staggering.


  1. Jeff and I were discussing this topic over beers last night while you were working. His point: don't we have a de facto national health insurance? People who are not insured or can't pay use the ER as their portal for healthcare, and the costs are (in part, anyway) passed on to those who are insured by the hospitals, thus the uninsured are actually insured, just in someone else's name.

    Now of course this is crappy, crappy healthcare. Not because ERs deliver poor healthcare, but because they are not a good place to receive primary care. They are excellent places for acute, reactionary care, but what we really need is a good infrastructure for preventive, proactive care.

    I think that from the government's perspective there is still the backlash over medicare having lined the pockets of many a hospital in previous decades, and now we are feeling the pinch back of tightening pursestrings.

  2. Well, you are of course right that the ER is a crummy case for primary and preventative care, but also bear in mind that the ER only delivers (by the nature of the thing) emergency care. So if you are uninsured and need your knee replaced or if you have painful gallstones and need your gallbladder out you will never get these taken care of through the ER. Those are elective surgeries.

    So, no, we don't have national healthcare -- there is a large subset of the population who are excluded from basic services. Also, a true national health insurance would be funded more along the mechanism of risk pooling rather than cost shifting. Rather than you being charged $500 for an ER visit to make up for the uninsured person who will not pay for their ER treatment, a risk-pooling strategy is funded in advance. Healthy people pay the full premium knowing that they are unlikely to fully utilize the service, and a small subgroup utilizes far more than they could ever pay out of their own pocket. this is in fact the mechanism by which every insurance company currently operates -- a national system would just make it all-inclusive.


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