[Mb-civic] Toward true national insurance - Robert Kuttner - Boston
swiggard at comcast.net
Sat Nov 26 06:18:13 PST 2005
Toward true national insurance
By Robert Kuttner | November 26, 2005 | The Boston Globe
IF YOU ARE a young adult, the parent of a young adult, a self-employed
worker in the new economy, or one in a low-wage job, you are on the
front lines of the health insurance crisis. Once, decent employers
provided health insurance as a fringe benefit. But that fringe is
If your employer doesn't provide insurance, good insurance is
astronomically expensive to purchase. More and more young adults,
convinced that they won't get sick, are just doing without. Politicians
of all stripes are hearing from constituents.
The Massachusetts Legislature is again wrestling with this issue. Each
of the three approaches in play -- the House bill, Governor Romney's
plan, and the Senate bill -- bumps into unfortunate fiscal and political
realities. The best approach, universal coverage with a single financial
pool (Senator Warren Tolman's bill), is not even on the agenda.
Romney claims we can deliver decent family health insurance for $200 a
month. That's fantasy. You can achieve that target only with very high
out-of-pocket payments, or by severely restricting treatment options.
Decent insurance for a family costs more like $600 a month. (That's why
the working poor can't afford it.) The governor also likes an
''individual mandate": Compel the uninsured to buy insurance; the poor
would get subsidies. But individual insurance is the least efficient way
to insure people.
The Senate approach would broaden coverage by shifting more
out-of-pocket costs to consumers. Employers could join a state-sponsored
pool that allowed very high deductibles and co-pays. This is politically
attractive until ordinary people realize the consequences. As health
policy it is a devil's bargain. The system is already shifting too many
costs to sick people.
The House bill would genuinely expand coverage to nearly everyone, by
requiring employers to either provide decent insurance or pay a new tax
to finance state-provided insurance. This is the best of a bad lot, but
it would retain our current fragmented system with its wasteful
administrative costs. And predictably, it runs into fierce opposition
from the business community as a whole.
House Speaker Salvatore DiMasi was quoted as wondering why businesses
that provide health insurance give political support to those that
don't. Mr. Speaker, it's called class solidarity. President Clinton ran
into the same problem a decade ago, when he naively expected large
corporations that hate government regulation to support universal heath
insurance because it would save them money.
Health insurance is the most vivid case of what political scientist
Walter Dean Burnham calls a ''politics of excluded alternatives." Polls
consistently show that over two-thirds of Americans want universal
tax-supported health insurance. Gallup found that 79 percent of
Americans want coverage for all, and 67 percent don't mind if taxes are
raised to pay for it. Fully 78 percent are dissatisfied with the present
system. Medicare, the one part of the system that is true national
health insurance (for seniors) is overwhelmingly popular.
There is no hotter political issue, nor one that strikes closer to home.
So, if Americans overwhelmingly want national health insurance, why
don't we get it? Three huge reasons: political, fiscal, and jurisdictional.
Politically, the immensely powerful private insurance industry would be
displaced by national health insurance. Nearly all corporations would
rather suffer with the devil that they know (escalating premiums) than
the devil they hate (an expanded role for government). Ideologically,
something supported by overwhelming majorities is seen as radical. (So
was Social Security until it was enacted).
Fiscally, a shift to national health insurance would require about $700
billion that currently goes through the private sector in charges to
workers and consumers and shifted to the public sector in the form of
taxes. The result would be a far more efficient and reliable system, but
many voters would see the increased taxes but not appreciate the savings
in premium costs, payroll deductions, or out-of-pocket charges.
Jurisdictionally, states like Massachusetts can perhaps make some
piecemeal progress, but it's hard to do this right in one state without
pushing the system toward further fragmentation. Medicare works because
it's a national program.
The best first step would be public, universal coverage for everyone
under age 25, a group relatively cheap to insure. That would be a big
political step toward true national health insurance, because it would
accustom working-age Americans to the value of a universal system. And
if it works for our kids and our parents, why not for everyone?
Robert Kuttner, co-editor of The American Prospect, can be reached at
kuttner at prospect.org. His column appears regularly in the Globe.
-------------- next part --------------
An HTML attachment was scrubbed...
More information about the Mb-civic