March 12, 2006

Healthcare Pt 5: What's the Solution?

Filed under: Random Stuff — Bob Gifford @ 7:55 pm

So far in this series of posts I have examined the biblical foundation for healthcare, the flaws in the current U.S. system, Bush’s proposals for healthcare, and some of the progressive alternatives for providing universal healthcare. All of this has been leading to the key question: as progressive Christians, what U.S. healthcare policies are we to advocate?

For us, the bottom line must be this: affordable universal healthcare. There are lots of policy proposals and points of view, both conservative and liberal, but if we are truly to care for the least of these then we must evaluate these alternatives based on whether they will achieve affordable and universal healthcare.

First, we need to recognize that the current employer-sponsored healthcare system is an historical accident that creates insecurity in employees’ health insurance coverage and hampers U.S. companies’ global competitiveness. It penalizes employers for doing the right thing for their employees, and can not provide affordable and universal healthcare. It needs to go.

President Bush’s Health Savings Accounts and high-deductible insurance program will, over time, undermine employer-sponsored insurance, and Bush would be happy for it to ultimately replace it. However, while the HSA approach is politically clever, it fails our test: it will not achieve universal healthcare. In fact, it will likely not achieve its stated goal of limiting healthcare costs, since patients spending over $4,000 a year in healthcare represent 80% of the costs, and HSAs will do nothing to contain them. So far, half of the 1 million Americans with HSAs have not put any money into their accounts, indicating that they are more interested in the low cost high-deductible insurance than in the HSA itself. This is not a path to affordable care, much less universal, care.

This leaves us with the three liberal alternatives: nationalized healthcare, single payer and multi-payer.


Nationalized healthcare would be an extremely hard sell to most Americans. It would require the elimination of the health insurance industry, government ownership of hospitals and clinics and employment of healthcare providers. While the VA has an admirable record, nationalized healthcare does not have such a great record in countries such as the U.K. Let’s exclude this option as an overly drastic step and instead look at more modest means.

Multi-payer is just such a modest step. We are all familiar with its most famous incarnation: Hillary Clinton’s managed competition plan. Her approach was an admirable attempt to achieve affordable universal healthcare without having the federal government be the single payer in the system. Health insurance companies were to continue collecting premiums and paying claims. And this led to its demise.

To prevent insurance companies from competing in the individual market by cherry-picking the healthiest customers, the Clinton plan had a layer of administrative oversight (i.e. bureaucracy) to regulate insurers. With multiple payers, both employer-sponsored and individual insurance pools, and regulation, it was very complicated. Insurers killed it because they didn’t want the regulation, and in the process killed multi-payer forever in the U.S. What’s ironic is that the only remaining alternative is single payer, which will have a much more dramatic effect on insurers. Health insurers torpedoed their one chance at a solution short of single payer.

Which brings us to single payer. It’s simpler than multi-payer, but more modest than nationalized healthcare. Single payer can guarantee universal coverage through subsidized premiums for lower income families. Insurance companies could continue to provide healthcare, but with the government contracting for the coverage instead of employers and unions.

Single payer has quite a constituency, with organizations such as the American Medical Student Association and Physicians for a National Health Program advocating for it. Sen. Conyers has already introduced a bill to implement it, although it won’t get voted on until the Democrats control Congress, and won’t get signed until the Democrats also retake the White House. Even then, it will face an uphill battle — after all, if health insurers could kill the Clinton plan, think what they would do to single payer.

But here is my challenge to any of you who object to single payer as being a “big government” program — how else would you achieve universal healthcare? Faith-based charities? The problem is completely beyond the ability of any charities to solve. An expanded Medicare program? It is a failure today — a bigger Medicare would be a bigger failure.

I fail to see any way to ensure that all Americans have affordable universal health other than the three options above, and from among these, single payer is the best. And if we are to take Jesus’ commandment to us to care for the least of these, we have no choice.

Next: structuring and selling single payer in the U.S.

6 Comments

  1. We are currently seeking progressive writers and editors.

    Comment by The Canadian — March 18, 2006 @ 8:31 am

  2. Wouldn’t it be simpler to follow the example of the minimum wage and require minimal EGHP coverage or a minimum employer contribution to funding Medicaid, coupled with universal access to Medicaid as the insurer of last resort for everybody?

    The mandate would have to specify what must be covered, much as government now regulates the plans that insurers can offer as Medicare supplements.

    The minimum plan would have to be at least as extensive as Medicaid, and Medicaid could itself be made more uniform throughout the states, and more extensive.

    That would have a number of advantages, including these.

    It would convert the insurance companies from opponents to supporters of universal health care. They would love the added business.

    It would introduce an element of price competition among insurance companies selling coverage-equivalent plans to businesses, just as we see now among insurance companies selling equivalent Medicare supplements.

    It would build on existing institutions.

    It would be impossible to brand as “socialism” or “socialized medicine,” and so would encounter less, little, or even no significant public opposition – though of course employers would still oppose it just as they oppose the minimum wage, overtime pay, OSHA, and anything at all that protects workers and diminishes profits.

    Too, public financing makes it too easy for conservatives to intentionally starve or sabotage a system, as they have done with FEMA and so many other government institutions.

    You are perfectly right that the true aim of GOP plans is to enable employers to dump their responsibilities for employee health care just as they are everywhere dumping their responsibilities for employee retirement funds.

    Liberals are foolish to play along, thinking they can nationalize that responsibility while the GOP think they can drop it right onto the shoulders of each an every individual.

    What is their plan for workers’ retirement? Let the workers save frugally and invest wisely.

    What is their plan for workers’ health care? Let the workers save frugally and invest wisely.

    If you think conservatives are strong enough, politically, to force the whole country in that direction, but too weak to prevent complete liberal nationalization of both burdens through some scheme of socialized medicine or an expanded and strengthened system of social security pensions, you are seriously mistaken.

    Comment by gaius sempronius gracchus — March 25, 2006 @ 6:10 am

  3. I really like your analysis of the current health care system, and of President Bush’s proposals, although I think you are a bit optimistic with regards to the public’s willingness to pay for a single-payer system. In the short-run, taxes would increase quite a bit to pay for it. Even if those taxes were more than offset by decreased expenses and increased salaries (as companies found other ways to compete for workers than providing health insurance), I’m still not convinced that enough voters/politicians would go for it. Politically, I think you might need to find a plan that looks and feels more like our current system.

    More importantly, what do you think should be done to make insurance more efficient? One of the biggest problems with American health care is that we spread risk extremely inefficiently. Too many people lack health insurance, and those that have it are spread across way too many plans and companies. If we go to a single-payer system, how would you suggest that payer go about pooling risk more efficiently across the system?

    Comment by Mike — March 28, 2006 @ 7:55 am

  4. You say “nationalized healthcare does not have such a great record in countries such as
    the U.K.” I was quite surprised to read this statement and wonder what your reason and
    evidence is for saying it. Do you have any personal experience of the UK NHS or are you
    just saying this on the basis of the UK media? What is the record of the NHS in the UK?
    Regards
    Andy

    Comment by Andy Willis — September 7, 2006 @ 12:43 pm

  5. Andy –

    I’m afraid I wrote this six months ago, so some of my sources are a bit hazy in my memory. For the record, I have no experience with the NHS, and even if I did, that wouldn’t represent anything other than a personal anecdote, and certainly not a record per se. My source was not the media, either in the US nor the UK.

    I don’t see it in the post right now, but I did read quite a few research reports from Brookings and elsewhere on survival rates and wait times for access to treatment, among other measures. For more detail, I’d encourage you to follow the links on this post and the others in my healthcare series — any statements I made were drawn from those sources.

    Comment by Bob — September 8, 2006 @ 4:13 pm

  6. Here are some really good sites about our healthcare in the USA.

    http://www.americansforhealthcare.org/
    http://www.healthcare-now.org/index.htm
    http://www.americanhealthcarereform.org/

    Comment by tulip — September 13, 2006 @ 8:12 pm

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