‘Going universal’

The WaPo reported yesterday that “health care is set to return to the national political stage in 2007, setting up partisan clashes in Congress that could end with rare vetoes from President Bush and help to define the 2008 presidential campaigns.” It’s about time.

Democrats have been trigger-shy about making serious changes to the system since 1994 and Republicans have largely satisfied with the status quo (Bush has argued that Americans already have too much health insurance). Regardless, this upcoming year will almost certainly see the debate begin anew, whether the GOP, the insurance companies, or the White House like it or not.

As is often the case, the public has been away ahead of their leaders on this. They can’t afford the status quo; they’d support increased government spending on the issue; and perhaps most importantly, Americans clearly want a universal health-care system.

With this in mind, the estimable Ezra Klein has a terrific op-ed in the LA Times today suggesting the arc of health care policy is long, but it tends towards universality. The key is shifting the debate towards rejecting an employer-based system.

Once a perk of employment, health insurance is now a necessity, and a structure that dumps such power, complexity and cost in the laps of employers is grotesquely unfair to both businesses and individuals. There’s no logic to an auto manufacturer running a multibillion-dollar health insurance plan on the side; it should stick to making cars. There’s no excuse for pricing the self-employed and entrepreneurial out of the market. And there’s no reason the owner of a three-employee start-up should have to go to bed with a heavy conscience because his coffee shop can’t pay for chemotherapy.

Quite right. Kevin Drum recommended a while back that a key part of this debate is “hammer[ing] on the notion that it’s crazy to rely on employers as the main healthcare suppliers in America…. Why should you have to pay the price every time your HR department decides to switch to a cheaper health plan? Or lose coverage if you get laid off? Or be forced to keep a dead end job forever because it provides health coverage and you’re uninsurable anywhere else?”

When Oregon Sen. Ron Wyden (D) unveiled a universal-care proposal two weeks ago, several corporate leaders took notice, and found a lot they could agree with. I can’t say I blame them.

One other key note: Ezra also explained how today’s current system originated. It was something of an unfortunate accident.

Few mention this, but the American healthcare system is something of a mistake. It blossomed out of a World War II tax reform meant to guard against corporate war profiteering. Liberals, with their usual combination of good intentions and inadequate foresight, imposed massive marginal tax rates on corporations, effectively freezing their profits at prewar levels. But the law had a loophole: Corporations could funnel their wartime riches into employee benefits, such as healthcare, thus putting the cash to use within their company. And so they did, creating the employer-based healthcare system.

Employers are ready to move away from this system; American families are ready to move away from this system; even insurance companies are openly discussing major reform proposals (which all suck, but that’s beside the point).

Bring on the debate.

We have to steal the corporations away from the Republican’ts by making the health insurance companies out to be the money-grubbing creeps that they are (rather than the corporate executives golfing buddies).

It’s time the share-holders stop having to carry this burden with it’s increasing uncontrolled costs and 23% administrative burden and shift that to the government and health care recipients where the administrative costs can be 2% and there is an incentive to keep costs down.

  • My conservative friends say, “Show me a Univ. healthcare plan that does not involve a tax hike, and I’ll support it”. Can somebody show me such a plan so I can start distributing?

    And don’t tell me the Center of American Progress’s plan, because theirs talk about “new value-added taxes”, whatever that means.

  • I hope politicians who support universal health care just keep hammering on the fact that we spend an average of twice as much per capita on health care as do countries with universal coverage. That is a HUGE amount of money down the drain. The old tired refrains against universal coverage are so flimsy that any politician worth his salt should be able to shoot them down blindfolded. But the easiest counter to the idea that the poor benighted people who live with universal health care are suffering under an inferior system to ours is simply this: Why doesn’t even one of those countries switch to our system (although, much to the chagrin of a couple of them, their conservative governments are trying to push in that directions)? Do you think they’re all just too stupid? (That, of course, would get an affirmative nod from many moron-Americans who consider themselves superior to everyone else).

    Well, maybe it’s not as easy to argue as I thought. Reminds me of when Adlai Stevenson’s campaign manager tried to assuage his doubts with the remark that “every thinking person will vote for you.” To which Adlai replied, “Then we have a problem, because I need a majority.”

  • “new value-added taxes”, whatever that means.”

    VAT’s are regularly used in Europe. They are a tax collected at every step of production and distribution, a sort of layered sales tax. As such they can be lower than the usual state sales taxes but they are much more prevasive and tend to add up.

    Note that the Republican’ts (some anyway) would love to get rid of the Income Tax and replace it with VATs or a national sales tax (which shifts the tax burden onto those who HAVE to spend a greater precentage of their money to live).

  • Ohioan,

    Perhaps you should ask your friends how much they spend on health care every year. Then point out to them that if they ended up paying that much extra in taxes it’d be a wash. Also you might point out to them the amount they have taken out of their checks already for medicare, and all the money that their employers pour into their health care plans now which would be available to them as salary increases with no pain to the employer.

    THEN point out the fact that we spend 2X the amount as a society compared to the “socialized medicine” countries, and ask them just where they think that money’s coming from. If they are deluded enough to think that it’s not coming out of their pockets in other ways (including most obviously the ways mentioned above, plus in higher prices for just about everything), then they’ve got a serious logic problem.

  • Better to create a truly progressive tax system than resort to VATs, which are absolutely regressive. It’s the old flat tax idea that the Heritage Foundation and their ilk love so much because the richer you are the more of your money you’ll get to keep. Horrible idea. The fact that VATs are so pervasive throughout the industrialized world is less a testament to their fairness as it is to the power that their economic elites still hold.

  • I am an independent IT contractor and have been since 1998. The worst part of being a contractor is medical insurance. That aren’t really many options for the self-employed. And the forms for the few options we have! Provide 7-10 years of your complete medical history with the resolution of every single problem documented or else you can’t get coverage for it. The initial rate quotes are useless because the rate gets adjusted upward based upon your medical history, so you really need to fill out a form for every insurer regardless of who is the lowest bidder. I had one insurer reject me outright because I had some squamous cells removed (same as Laura Bush) because they are a type of skin cancer and the word “cancer” terrified them. And don’t even think about trying to get insurance for having a baby.

  • By relying on corporations to provide health care, this makes them uncompetitive with businesses from around the rest of the world where health care is provided by the government. Whenever anyone bemoans the fact that the US is losing its trading edge, or that jobs are migrating off-shore, this should be brought up. A hidden cost of all of this is that our other regulations such as environmental and labor controls are oftened weakened for the exact same argument – anti-competitive effects on US businesses. It’s the same logic that requires the drinking age to be raised and drinking laws to be made tighter so as to save X number of lives at the margin, while ignoring the amount of increased deaths in favor of “efficiency” when allowing truckers to drive longer hours between breaks.

  • This sounds too good to be true…
    http://www.lewin.com/NR/rdonlyres/37BD21DB-BEFE-4C2F-AFEA-802BDF91EAD7/0/HealthyAmericansActAnalysis.pdf

    In fact it might be… from the analysis:

    We assume that the savings to employers would be passed-back to workers in the form of increases in wages. This reflects the HAA requirement that employers “cash-out” their benefits plans. It also reflects economic theory and research indicating that changes in employer benefits for health care are, in the long run, passed back to workers in the form of wages or some other form of compensation such as pensions or disability insurance.

    This reflects that the employer’s true cost of employing workers includes all compensation costs including: wages less employer payroll taxes, health benefits, pensions, and other non-cash
    benefits. In competitive labor markets, eliminating the health benefits (or any other form of compensation) would bid-up other forms of compensation such as wages so that aggregate compensation levels are largely unchanged.

    So, who’s the first one that’s going to trust their boss in returning all their health care benefits in the form of wages??? Perhaps that is why some of the unions are against such a plan…

    http://news.yahoo.com/s/usnw/20061213/pl_usnw/food_and_commercial_workers_union_leader_raises_concerns_over_healthy_americans_act134_xml

  • “Show me a Univ. healthcare plan that does not involve a tax hike, and I’ll support it”.

    So, who’s the first one that’s going to trust their boss in returning all their health care benefits in the form of wages???

    How about we kill these two birds with one stone? No tax hikes to pay for universal coverage and elimination of ALL corporate welfare (call it “ending welfare as we know it” hehe). No tax hike needed to pay for universal coverage. No windfall to corporations.

  • Maybe this entire health-care monster needs to be examined from an out-of-the-box perspective.

    If you “step out of the box” and look at the entire picture from a distance, you’ll find that the greater portion of costs for health-care is the massive amount of money paid to shareholders. Dividend payouts from big pharma, insurance companies, and provider-groups that own hospitals and emergency trauma centers crossed the borderline between “excessive” and “obscene” several years ago.

    The solution is simple—take out “the middleman.”

    By converting over to a single-payer model, the final “payer” becomes the federal government. They pay for everything by utilizing a “per-employee tax” assessed to employers. This “tax” would be, if the shareholder-dividend is excluded from the matrix, substantially less than they are paying now. It looks something like this:

    Scrap out the profit-taking by swinging all premium resources to Washington. That means eliminating the corporate insurance companies (or at the very least, their health-care component) and the stockholder aspects of the current model.

    Washington, in turn, needs qualified people to manage this thing at the local level—so as to prevent this from becoming a bloated, centralized, bureaucratic behemoth (a rare issue upon which I acknowledge that conservatives are right about), so the federal government “absorbs” the local insurance agencies. They already exist; they know the needs of the customer base. Removing the restriction set up by their corporate masters, local agencies can depend on the recommendations of an individual’s physician, instead of an absentee set of benchmarks and pre-notification requirements. Immediate benefits include:

    Health-care transition periods (the period of time between needing care and obtaining care) becomes nearly non-existent. People get help quicker; they get well quicker, and become less of a burden on the system.

    Less people take “what needs only an office visit” to an emergency room.

    Big Pharma, no longer a profit-driven entity, can spend more on R&D with only a fraction of their established profit needs—passing the bulk of the expenditures reduction back to the federal unit, which in turn further reduces the “tax” on employers.

    A healthier population in the workplace means less downtime; less lost production; and work that’s performed both faster AND better. (imagine that—America being able to go toe-to-toe again with other countries in worker productivity. And no—I don’t give a flying frankfurter if the Chinese don’t like it.)

    A healthier population in the school means kids learn both faster and better, and teachers have more time/effort/energy to invest in such “mundane” things as continuing education. innovative curriculum ideas, and actual classroom work—which in turn allows for more resources being invested in better classrooms, better technology, and inproved teacher:student ratios. (WOW—NCLB could work with this—and saves taxpayers lots of money to boot. We could rename it the TTANTTBNCLB— the Thanks-To-Americans-No-Thanks-To-Bush-No-Child-Left-Behind Act. )

    A healthier population in the home means less trips to doctors, hospitals, and drugstores. (A lot less trips—so now OPEC will probably declare some gods-awful jihad-thingie on me for daring to suggest reduced oil consumption. Ask me if I care.)

    The only things in the way are corporate boardrooms and stockholder proxies. If they get nasty about it, we can always “bring the Army home from Iraq….”

  • My health insurance (I’m self employed) went up 57% this year. Since I seem to break bones or tear ligaments when I have no insurance and none of those happen when I have health insurance, I will continue to pay, but damn.

  • “Scrap out the profit-taking by swinging all premium resources to Washington….Big Pharma, no longer a profit-driven entity, can spend more on R&D with only a fraction of their established profit needs…”

    So, Steve, What exactly is the incentive for Pharma companies to conduct reserach if they are no longer profit driven??? (i.e. what is the reward for the millions & millions of dollars of R&D spending risk??)

    “Washington, in turn, needs qualified people to manage this thing at the local level—so as to prevent this from becoming a bloated, centralized, bureaucratic behemoth”

    All I have to say to that is” “LOL!”

  • Well, I never thought I’d see the day when I’d agree with JRS Jr. on anything, but I do have to agree that Steve’s logic about Big Pharma operating without a profit motive doesn’t seem to make sense. Socialized medicine isn’t going to socialize the pharmaceutical industry. Hopefully it’d put more pressure on them to be more reasonable in their pricing, though.

    So much for hell freezing over, JRS. Stopped clock twice a day thing…

  • “Republicans have largely satisfied with the status quo”

    WTF??

    In what sense were the Republicans ever satisfied with the “status quo” when the profits of giant corporations could be increased?

    Republicans have not been satisfied with the status quo at all. They have been very busy making the system worse for most people to make it more profitable for insurance companies, Big Pharma and private hospital chains, among other worthy supporters of the Republican Party.

    Democrats have to learn to never miss an opportunity, however small, to define the Republican Party agenda for what it is.

  • Um…”Junior….”

    The incentive is the cash register continuing to go “cha-ching.” The incentive is knowing that there isn’t some infernal, bean-counting proxy, sitting in a board room, knowing absolutely nothing about pharmaceuticals, telling the R&D people what to produce.

    Oh—and you find something about decentralized quality undesirable? That’s some serious pre-11/7 thinking you’ve got going on between your ears. I’d prescribe a healthy dose of hemlock for that…or at least an extended vacation from the bubble….

  • My conservative father-in-law is a big fan of the flat tax idea, and often tries to convince me of it. Of course I always argue something similar to Lance and President LIndsay, that it’s horribly regressive (ie. puts the greatest tax burden on those who can least afford it).

    I had an idea last time that he actually agreed with, though I don’t understand how taxes work well enough to say I even agree with it (I think I do, but could be convinced otherwise). What if there were just a magic number that’s required to live. Food, clothing, rent/mortgage, etc. Say it’s $30,000 (adjusted for dependents, maybe area you live in). Don’t tax that amount at all, then go ahead and flat rate tax the rest, if any.

    Would that be a progressive system that liberals and conservatives could agree on, or is either he or I out of bounds for our respective “side”?

  • CB makes a very good point that healthcare is the huge (think elephant in the corner of the room) issue that may get smothered by Iraq and other issues in ’08. Whatever party can begin to seriously address it in a meaningful and understandable way will get a huge number of votes. For most Americans, terror is not an Arab guy with a bomb, it’s an illness that sends the family to the poorhouse.

    There is a side current going on in the comments that I’d like to add to. JRS Jr., who I always figured to be a supply sider, points out that the market is not out there to do right by humanity, which we all assume is a goal of healthcare, but to do what makes money. And that’s one of the best defenses of the liberal argument for the role of government: to step in when the markets are inefficient at doing the right thing. I’m not in favor of regulating everything to death, but I believe good government can nudge business to do what society needs of it. Good point JRS. I didn’t think you’d be so skeptical of the Republican view of the market being society’s absolute savior.

  • Hey everybody. Kari Chisholm here. My full disclosure again — I’m working with Senator Wyden to organize netroots support for his universal health care plan. There’s lots of info for you over at Stand Tall for America – and you can join the campaign there too.

    Anyway, some answers to your questions…

    JRS Jr.: So, who’s the first one that’s going to trust their boss in returning all their health care benefits in the form of wages?

    Actually, in Senator Wyden’s plan, that’s a legal requirement. And the plan actually makes it the 2006 benefit level – so they won’t be able to cut your wages between bill introduction, passage, and implementation.

    Dennis: The worst part of being a contractor is medical insurance. That aren’t really many options for the self-employed. … I had one insurer reject me outright …

    I’m totally with you. I’m self-employed myself, and it’s a nightmare. A big plus for the Wyden plan is that it would bring parity between the self-employed and everyone else. Everyone would now buy their own plan – and that means lots of good plans for everyone. Oh, and the insurance companies won’t be able to reject you or raise your premium based on pre-existing conditions, age, gender, or genetic info. Cool stuff, eh?

    Steve… By converting over to a single-payer model…

    Yeah, single-payer sounds good to me. Certainly, we don’t need a fight between single-payer and the Wyden plan. The key is to focus on outcomes — universal, comprehensive, affordable, nondiscriminatory, portable health care.

    Personally, I don’t think single-payer has anywhere near the number of votes it needs to get moving — which is why Wyden’s plan is so exciting. It gets the ball rolling, and will provide universal health care in just two years. 46 million Americans have no health care, and the rest of us suffer from job lock and other kinds of health insecurity.

    Hope that helps!

  • Ben… I’m not flaming you but I don’t think you realize how little money most Americans really earn. We have this image of ourselves as a wealthy country but it ain’t fairly distibuted. Especially given the last thirty years. Income and wage fairness has to be part of the overall agenda or any savings on anything (remember the “peace dividend”) get diverted to profits.

  • “The key is to focus on outcomes — universal, comprehensive, affordable, nondiscriminatory, portable health care.” – Kari Chisholm

    You left out GOOD. We get worse medical outcomes in this country for twice the cost. People get bad infections, we create drug resistent deseases, people are given the wrong drugs in hospitals, the wrong limbs or organs are removed…

    … etc. Really great system, what?

  • Thanks for your reply, Dee. I won’t take insult unless I think it’s intended, I’m just trying to get a better understanding. I have no doubt that there are plenty of things that I don’t realize. Maybe my number is way off. Maybe it should be lower. My point though, is that I think people should be able to earn a “living wage” untaxed. If you make less than this, then maybe you shouldn’t be the one taxes are taken from. If you make more… more power to you, but you need to pay taxes on that. I think there is some agreement on that in general (ie. many/most items in a grocery store, and some clothing stores, are untaxed because these are necessities. Restaurants and Prada are taxed because these are luxuries).

  • Comments are closed.