To Guarantee Universal Coverage, Require It

CAL/AAEM News Service pottsbri@yahoo.com
Tue, 11 Feb 2003 06:44:31 -0800 (PST)


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Interesting article forwarded by Paul Windham.

 

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January 31, 2003To Guarantee Universal Coverage, Require ItBy TED HALSTEAD


ASHINGTON — Among President Bush's top priorities, he said in the State of the Union address, is "high quality, affordable health care for all Americans." Yet he offered precious few specifics. With nearly three million Americans losing their health insurance in the last two years alone and health care costs rising at the highest rate in a decade, America needs a bold plan.

The most promising solution to America's health care crisis is mandatory insurance. For the same reasons most states require drivers to carry car insurance, the federal government should require all Americans to purchase basic health insurance. Those who cannot afford the full cost should receive public subsidies. Mandatory self-insurance would provide fully portable coverage to all Americans, while lowering insurance costs, raising the quality of care, maintaining a private insurance market and offering citizens more choice.

The grand bargain underlying compulsory health insurance would be universal coverage in exchange for universal responsibility. Of the 41 million Americans without health insurance, a full two-thirds are below the age of 35. Mandating tens of millions of young and relatively healthy Americans to join the insurance risk pool would drive down the costs for everyone. Insured patients are also less likely to rely on expensive hospital emergency rooms for their basic medical care.

Most of the uninsured are members of the middle class; a third have annual incomes of more than $50,000. Requiring them to devote up to a certain percentage of their income to purchasing basic coverage would be imposing a significant, though not ruinous, financial burden — but they themselves would be the primary beneficiaries. Not only would they receive better care, with its obvious benefits (regular checkups and peace of mind, for example), but their premiums would be significantly lower than those available to them now.

The new system would also be an improvement for Americans who receive health insurance from their employers. They would be able to select their own insurance policy and level of coverage from among private providers, instead of being limited to the one selected by their employer. They would also be able to keep the policy and doctors of their choice as they move from job to job. Employers, meanwhile, would not stop paying for coverage — they would simply contribute to the policy of their employee's choosing. After all, employer-subsidized health insurance is voluntary now, and there is little reason to believe that employers would suddenly stop providing it.

Mandatory self-insurance would also increase the quality of care. Today, most Americans change health insurers when they change jobs: average tenure with any given insurer is a mere couple of years. By enabling citizens to stay with a single insurer for life, mandatory self-insurance would increase insurers' incentives to invest in disease prevention and long-term preventive care.

Making mandatory self-insurance work would require new regulations and changes in our health care framework. For instance, America would no longer need to maintain a separate Medicaid system for the very poor. Insurers would have to accept all comers and be prevented from discriminating on the basis of pre-existing conditions. Ensuring that all citizens self-insure need not be difficult; those unable to prove that they had done so on their annual tax form could be enrolled in a default private plan by the government, and either billed or subsidized accordingly.

A policy of mandatory health insurance defies the usual political spectrum. Its universalist dimension should appeal to the left, while its market-based orientation should appeal to the right. The interesting question is who will be first to lay claim to this idea: President Bush or one of the Democratic presidential candidates. 

Ted Halstead, president of the New America Foundation, is co-author of "The Radical Center: The Future of American Politics."

=========================================


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<P>Interesting article forwarded by Paul Windham.</P>
<P><IMG alt="The New York Times" hspace=0 src="http://graphics7.nytimes.com/images/misc/logoprinter.gif" align=left border=0><!-- context ad reference Position1 --> <BR clear=all>
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<H5>January 31, 2003</H5><NYT_HEADLINE type=" " version="1.0">
<H2>To Guarantee Universal Coverage, Require It</H2></NYT_HEADLINE><NYT_BYLINE type=" " version="1.0"><FONT size=-1><STRONG>By TED HALSTEAD</STRONG></FONT><BR><BR></NYT_BYLINE>
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<P><IMG alt=W src="http://graphics7.nytimes.com/images/dropcap/w.gif" align=left border=0>ASHINGTON — Among President Bush's top priorities, he said in the State of the Union address, is "high quality, affordable health care for all Americans." Yet he offered precious few specifics. With nearly three million Americans losing their health insurance in the last two years alone and health care costs rising at the highest rate in a decade, America needs a bold plan.</P>
<P>The most promising solution to America's health care crisis is mandatory insurance. For the same reasons most states require drivers to carry car insurance, the federal government should require all Americans to purchase basic health insurance. Those who cannot afford the full cost should receive public subsidies. Mandatory self-insurance would provide fully portable coverage to all Americans, while lowering insurance costs, raising the quality of care, maintaining a private insurance market and offering citizens more choice.</P>
<P>The grand bargain underlying compulsory health insurance would be universal coverage in exchange for universal responsibility. Of the 41 million Americans without health insurance, a full two-thirds are below the age of 35. Mandating tens of millions of young and relatively healthy Americans to join the insurance risk pool would drive down the costs for everyone. Insured patients are also less likely to rely on expensive hospital emergency rooms for their basic medical care.</P>
<P>Most of the uninsured are members of the middle class; a third have annual incomes of more than $50,000. Requiring them to devote up to a certain percentage of their income to purchasing basic coverage would be imposing a significant, though not ruinous, financial burden — but they themselves would be the primary beneficiaries. Not only would they receive better care, with its obvious benefits (regular checkups and peace of mind, for example), but their premiums would be significantly lower than those available to them now.</P>
<P>The new system would also be an improvement for Americans who receive health insurance from their employers. They would be able to select their own insurance policy and level of coverage from among private providers, instead of being limited to the one selected by their employer. They would also be able to keep the policy and doctors of their choice as they move from job to job. Employers, meanwhile, would not stop paying for coverage — they would simply contribute to the policy of their employee's choosing. After all, employer-subsidized health insurance is voluntary now, and there is little reason to believe that employers would suddenly stop providing it.</P>
<P>Mandatory self-insurance would also increase the quality of care. Today, most Americans change health insurers when they change jobs: average tenure with any given insurer is a mere couple of years. By enabling citizens to stay with a single insurer for life, mandatory self-insurance would increase insurers' incentives to invest in disease prevention and long-term preventive care.</P>
<P>Making mandatory self-insurance work would require new regulations and changes in our health care framework. For instance, America would no longer need to maintain a separate Medicaid system for the very poor. Insurers would have to accept all comers and be prevented from discriminating on the basis of pre-existing conditions. Ensuring that all citizens self-insure need not be difficult; those unable to prove that they had done so on their annual tax form could be enrolled in a default private plan by the government, and either billed or subsidized accordingly.</P>
<P>A policy of mandatory health insurance defies the usual political spectrum. Its universalist dimension should appeal to the left, while its market-based orientation should appeal to the right. The interesting question is who will be first to lay claim to this idea: President Bush or one of the Democratic presidential candidates. </P>
<P><EM>Ted Halstead, president of the New America Foundation, is co-author of "The Radical Center: The Future of American Politics."</EM></P>
<P><EM>=========================================</EM></P><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/O=1/I=brandr/vday03/text/flow/*http://shopping.yahoo.com
/shop?d=browse&id=20146735">Yahoo! Shopping</a> - Send Flowers for Valentine's Day
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