Ronald Brownstein argues that it’s time to revisit universal health coverage:
Ten years ago, a vicious cycle of rising prices and declining access forced health care to the top of the national agenda. Now that destructive spiral is spinning again — with the same result.
Everywhere signs are proliferating that the health-care system is breaking down under the same pressures that inspired President Clinton’s ill-fated crusade to guarantee universal coverage.
Three consecutive years of double-digit increases in health insurance premiums are straining employers and igniting conflicts with employees asked to bear part of the burden. Health-care costs have become a growing factor in labor confrontations, like the two bitter strikes underway in Southern California.
The rising costs are also compelling more employers to stop offering health coverage at all — and more employees to decline it even when it’s offered. Since President Bush took office, the number of Americans without health insurance has soared by 3.7 million, to 43.6 million, the biggest two-year increase since his father was president.
These problems of cost and access are inextricably connected. It’s easy to see how rising costs translate into reduced coverage. But the reverse is also true. The growing number of Americans without insurance means that doctors and hospitals have to provide more uncompensated care that must be subsidized by the premiums of those with insurance. As Bruce G. Bodaken, chairman and president of Blue Shield of California, put it in a speech last winter: “In essence, we are charging the private health-care system a hidden tax, a tax that can’t be sustained.”
Brownstein assesses the plans offered by the current crop of presidential contenders–including George W. Bush–and finds them all flawed.
One promising model might be the plan that Bodaken of Blue Shield proposed last winter that would impose a mandate on employers to provide coverage, a mandate on individuals to purchase coverage (which solves the problem of the young and healthy skewing the risk pool by opting out), and provide government subsidies for both.
In an economy that already spends $1.6 trillion on health care, the cost of universal coverage is almost trivial: about $75 billion more a year. But it won’t be possible to find those funds unless business, individuals and government all shoulder their share of the load.
Of course, figuring out what “their share” is has been precisely the issue.
