RSS Feed MenuTens of millions of Americans lack health insurance. Extending coverage to them has been a core goal of health reform proposals since the 1960s. President Richard Nixon offered a universal health plan in his first administration, but since then Republicans have hesitated to commit the nation to so costly an undertaking. Is it time to rethink? Should Republicans accept universal coverage as a goal? We posed this question to NewMajority’s contributors.
No. What we are discovering is a new “third rail” of American politics – universal health coverage. The left has promoted this issue for 60 years, and ever since Truman, it has driven them over one cliff after another.
The U.S. has a system of universal coverage now – it’s called “show up at the emergency room” – and while it is far from perfect, the overwhelming majority actually seem pretty content with it – at least any time we get down to the specifics of some other form of “universal coverage.” Every other scheme put forth, or tried in the states, does indeed involve intrusion into personal decision making on our most intimate issues (our health) or (and sometimes, “and”) outrageous costs.
This does not mean Republicans should do nothing. We should push to allow sales of policies across state lines; we should continue to promote health savings accounts; we can consider targeted subsidies; we should reduce coverage mandates; and we should look further – mindful of the political consequences – at ways to decouple insurance from employment.
But adopt universal coverage? It’s bad economics, bad for liberty, and by now we should be realizing, universal coverage is bad politics.
To read other contributions to this symposium, click here.
ottovbvs // Aug 22, 2009 at 5:46 pm
“The U.S. has a system of universal coverage now – it’s called “show up at the emergency room” – and while it is far from perfect, the overwhelming majority actually seem pretty content with it ”
………And tell me Mr Smith do you have health insurance or do you rely on “showing up at the emergency room?”
nwahs // Aug 22, 2009 at 6:33 pm
I’m easy – decouple insurance from employment. Its a bad, anti-market system. Let my employer raise my salary and let me take care of my insurance.
sinz54 // Aug 22, 2009 at 8:02 pm
“The U.S. has a system of universal coverage now – it’s called ’show up at the emergency room’ – and while it is far from perfect, the overwhelming majority actually seem pretty content with it”
Of course. Because the overwhelming majority don’t use it. They have their own private insurance.
Emergency room medicine is for those who have no insurance. I’ve been to E.R.’s for some genuine emergencies (bleeding, etc.). Every time I go there, I see that most of the folks sitting in the E.R. waiting for routine medical care are lower middle class or poor; a lot of them are immigrants who don’t speak English. Those more affluent who go to E.R.’s with genuine emergencies (asthma, bleeding, etc.) are fast-tracked, so they don’t have to wait in the waiting room at all.
sinz54 // Aug 22, 2009 at 8:06 pm
Universal coverage is bad politics for one and only one reason: It would split the GOP base (which is opposed to Government-mandated universal coverage) off from its party leadership, splitting the party at a crucial time. That would outweigh any benefit that such a stance might have among moderate Independent voters right now.
In the congressional election year of 2010, that equation may change. When they’re trying to win an election, a party’s base is more willing to tell the voters anything they want to hear, if that’s what it takes to win a majority (cf. “Blue Dog Dems” and “Fighting Dems”). But between elections, in tussles over budget and legislation, not so much.
Brad Smith // Aug 23, 2009 at 12:07 am
Dear Otto,
I have health insurance. Meanwhile, please read more closely and try to understand what people are saying before typing your responses. When I say the overwhelming majority are “content with it,” “it” refers to “universal coverage” through the admittedly imperfect system of requiring emergency rooms to take all comers. When presented abstractly, Americans like universal coverage. When faced with the actual choices needed to bring it about, most Americans understand that resources are limited and that life requires trade offs. Given the actual choices necessary to bring about some form of national health insurance, they recognize that the losses in freedom and the enormous costs are not worth it. They are content with a system in which the overwhelming majority have good insurance (or have chosen not to purchase insurance), extraordinary quality of care, unparalleled access, and expansive freedom of choice, and in which the small minority who are not insured – far less than the 46 million figure bantered about by the left – get care through ER services.
I presume it is not your position that all Americans should have “equal” care. Such a position would be enormously costly, if it could be afforded at all, or would require lowering the quality of care and the degree of access and choice for a very substantial percentage of the population – a highly unpopular position.
The GOP would economically irresponsible, morally wrong (because of the loss of freedom and health care quality), and ultimately politically stupid to endorse universal coverage. We (that’s we Republicans – I am pretty sure that you are not in that group) can, should, and will continue to press for improvements in the health delivery and insurance systems. Sadly, Democrats have stood in the way of such real improvements, opposing even mild tort reform, fighting against Health Savings Accounts, mandating expensive and unnecessary coverages that make it harder to afford insurance, and demogoguing proposals to uncouple insurance from employment (as Obama did last fall to Senator McCain). Sometimes you have to let go of ideology, but Democrats are unwilling to do that with health care, and so, once again, even if the Democrats jam something through in the fall, the GOP will rightfully benefit at the polls.
- BAS
Spartacus // Aug 23, 2009 at 12:12 am
In order to believe that everyone in this country gets care and it’s just a matter of whether it occurs in an emergency room or a regular doctor’s office, you must be either completely ignorant about the uninsured or you are simply an ideologue with a political agenda.
People, many of whom are solidly middle-class, are dying in this country for no other reason than the fact that they do not have health insurance. This is an indisputable fact.
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/view/
http://www.theroot.com/views/deamonte-s-toothache
ottovbvs // Aug 23, 2009 at 12:15 pm
“6 Spartacus // Aug 23, 2009 at 12:12 am
In order to believe that everyone in this country gets care and it’s just a matter of whether it occurs in an emergency room or a regular doctor’s office, you must be either completely ignorant about the uninsured or you are simply an ideologue with a political agenda.’
Brad Smith // Aug 23, 2009 at 12:07 am
…………Mr Smith I read very carefully what you said so there’ no need for the smart alec attempted put downs….You said”
” The U.S. has a system of universal coverage now – it’s called “show up at the emergency room” – and while it is far from perfect, the overwhelming majority actually seem pretty content with it – at least any time we get down to the specifics of some other form of “universal coverage.” Every other scheme put forth, or tried in the states, does indeed involve intrusion into personal decision making on our most intimate issues (our health) or (and sometimes, “and”) outrageous costs.”
……..Seems pretty clear to me …….you’re giving us lectures on how happy people are with a system of which you personally have no experience……so let me remind you of something since you apparently are not aware of it but then why would you be …….Emergency rooms are NOT FREE………you are billed for procedures performed there if you have no insurance……furthermore you are likely billed at full tariff not an insurance industry price……..a personal anecdote…..a young guy of around 27 who takes care of the fences and arbors on my property broke his leg a couple of years ago and had to use the emergency room…..a break in two places……admittance to hospital…..emergency surgery……about a three day hospital stay…….bill $54,000……I advised him to flee the country and join the French Foreign Legion…… Of course he could wait for the largely chimerical set of formulas you advance to happen …..but I fear he’d be waiting a long time…….and that’s your goal isn’t it?…….by the way the 46 million estimate you dismiss as “bantered about” is the official census figure
Brad Smith // Aug 23, 2009 at 1:01 pm
Poor Otto, so long on indignation, so short on understanding and comprehension. Look, Otto, my little buddy, maybe when you first read my post, you thought I was referring to the quality of ER care for the poor when I wrote that “the overwhelming majority seem pretty content with it.” I think pausing to read carefully what I wrote would have shown that that was not true, and that’s why I urged you – as I urge my students, my kids, and try to remind myself – not to respond too quickly. Pretend you still have to write a letter. But by my second post, it should have been absolutely clear to you that I was saying that the overwhelming majority of Americans are happy with the overall system of health care delivery and payment, including that part which shunts some Americans off to emergency rooms, which is why “comprehensive” reform to provide universal covereage is the new “third rail” of American politics.
The 46 million uninsured figure, as I think you know, is highly misleading. I don’t suggest it is not a “official census figure,” only that it is highly misleading: Just like batting average is an “official baseball stat,” but if you only look at a player’s batting average, without some context and use of other stats to flesh out the picture, you can get a very misleading picture of the player’s abilities. Why, did you know that Walt “No Neck” Williams was a better baseball player than Harmon Killebrew? He had a .270 lifetime batting average, and Killebrew’s was only .256. And that’s an official baseball stat, so you can’t question me or suggest I am being misleading! Similarly, the 46 million number is repeated as a religious mantra by the left out of a) ignorance (in some cases) or b) intentional effort to obfuscate the nature of the problem.
Finally, I have no idea what “set of formulas” you think I am advancing. Do you mean policy options to improve insurance affordability? If that is what you mean, I’ll just say that I’d hate to have spent the last 60 years waiting around for government provided “universal coverage” that you are advancing. I don’t think it quite fair that if I oppose your policy proposals, I am somehow a bad guy who must want to delay reform so that people will suffer, because ultimately I don’t care if people suffer – that’s even my goal, you suggest – but if you oppose my policy proposals to make insurance more affordable now (at a much more reasonable cost, by the way, and better preserving the best elements of system while providing for greater personal freedom), you’re not guilty of wanting your friend to keep going to ER while waiting (60 years now) for your proposals to pass. Seems like a double standard to me.
ottovbvs // Aug 23, 2009 at 1:46 pm
Brad Smith // Aug 23, 2009 at 1:01 pm
“Poor Otto, so long on indignation, so short on understanding and comprehension. Look, Otto, my little buddy, ”
………Spare me condescending poor otto stuff, it bad manners and although it might impress your 19 year olds but it’s a poor substitute for a strong case
“The 46 million uninsured figure, as I think you know, is highly misleading. I don’t suggest it is not
a “official census figure,” only that it is highly misleading”
…….I don’t know anything of the kind………. you actually admit 46 million IS the official govt figure but then give a para of irrelevant rambling about baseball but no actual numbers to back up your contention that it is actually substantively incorrect…..is this the standard of proof at your university?
“Finally, I have no idea what “set of formulas” you think I am advancing”
……..Reread your penultimate para………if we’d stood around waiting for social security and Medicare from Republicans of your mindset we’d still be waiting for those……the problem is that most of your formulas (sorry policy options….er aren’t they synomymous in this context?….oh well never mind) are either largely unworkable or are completely out of scale with the problem……in short a smokescreen for inaction
Spartacus // Aug 23, 2009 at 3:37 pm
These people simply are not serious. They know it is an indisputable fact that most Western countries provide universal coverage without bankrupting their governments or their private sector businesses. These people also know that the citizens in these other Western countries achieve the same or better health outcomes from their healthcare systems than we do in the U.S. Yet, they insist that it’s impossible to provide universal coverage in the U.S. without bankrupting the country.
Mr. Smith and his ilk are either too uninformed about healthcare or they are simply willing to lie and ignore facts that demonstrate their nothing more than ideological hacks.
Brad Smith // Aug 23, 2009 at 3:54 pm
See Otto, you keep talking about things you don’t know about. My students aren’t 19 – they range from 22 to about 60, all graduate students. They’re pretty smart, by the way.
Understanding the 46 million figure is basic to using it in debate. So let’s see who is included there:
1. You’ve got, according to the U.S. Department of Health and Human Services, an estimated 6.4 million who in fact are insured under medicaid or SCHIP, but who mistakenly tell the census taker from that they are uninsured. Obviously, one has to estimate this number… but this is the “official” estimate of the HHS.;
2. You’ve got about 4.3 million who are eligible for medicaid of SCHIP but have not signed up. If they go to an emergency room for care, they will be automatically signed up and their care paid for by the government.
I don’t know that by any definition we can call people “uninsured” when in fact they are insured, or when in fact they are immediately eligible for insurance the first time they need health care. And that’s close 11 million off the “46 million” figure right there. Continuing:
3. There are about 9.3 million who are not U.S. citizens. Whether or not they should be covered by the U.S. government is a valid question. Some of them are illegal aliens and others are legal.
4. There are about 10.1 million who have incomes of at least 3 times the poverty level. Many of these people could obtain insurance and could afford it but have chosen not to.
5. Of the remaining 15 to 16 million, about 5 million are adults between the ages of 18 and 34, without children. For many of these people, health insurance is a low priority and they choose not to take jobs that provide it or not to purchase it themselves, in favor or higher wages or spending the money on other things.
That leaves about 10 to 11 million others who are uninsured.
Thus, if we take only those who are insured, but mistakenly tell the census taker otherwise, and those who are eligible for and can be immediately enrolled in a government program on arrival at the ER, we are already down to 35 million uninsured. From there there are many considerations – should the government guarantee health insurance to illegal aliens? There are good arguments both ways, but many people who favor guaranteed health care would not include illegals in that group. A smaller percentage would not include legal aliens in that group. Do taxpayers have an obligation to foot the bill for those who earn 3oo% or more of the poverty level but do not have insurance? Why don’t they have it? Should we force young, healthy persons who would rather not spend their money on insurance to buy insurance? These are all good questions, and different people will answer them differently. But just throwing around the “46 million” number doesn’t really give us a very good handle on the problem, as it both oversimplifies and exaggerates the problem.
Beyond all that, of course, if 46 million are uninsured, that means over 250 million are insured. Surveys consistently show that about 80 percent of the insured consider their coverage “good” or “excellent.” So while most of them (most of us, really, as I’m in this group) do want to help the uninsured, most do not want to do so at the expense of damaging what is good about their own insurance. The grandiose schemes of the left have never been able to solve that dilemma. Which is why universal coverage is, again, the new “third rail” of American politics.
Brad Smith // Aug 23, 2009 at 4:07 pm
Sparty,
Now, now. You know, too, that there is good and bad in every system. The U.S. system is clearly superior to other systems in many ways. One way in which it is superior to almost every other country is that it keeps the size of the state smaller. Now, you may not consider that a value. But some of us do. I rank freedom and limited government quite high as a value.
Once we move beyond that, we know that the U.S. is, in fact, superior to almost every other system in at least some ways. We have shorter waits, for example, than England or Canada, and than many other countries. We have more consumer choice than in some countries. We have better outcomes than many systems. We have a history of lower unemployment and higher economic growth than many countries, which may relate to our health care system. At the same time, the countries you admire have advantages over us. I’ll bet that there is some way in which even Zimbabwe’s health system can be said to be “better” than that in the U.S., so certainly there are ways in which the French or Canadian or even the terrible British system are better.
What I’m getting at it that you can’t just say, “oh, other countries have it, so people like Smith are either liars or meenies.” Nor is it quite fair to suggest that we’ve said universal coverage will “bankrupt” the country. I don’t think I’ve said that anywhere. I’ve said it would cost a whole lot of money, or result in much worse care. We can do lots of things without bankrupting the country, but we can’t do everything. So the question is, should we spend a whole lot more to try to achieve your objectives? I submit that every time Americans are asked that in a concrete fashion, they say, “no.” They’d rather spend the money on roads, or education, or flat screen TVs, or other social services, or housing, or on their own health care, or on the PBS, or who knows what. Your normative choice – you want to spend lots more on health care, it appears – is not the normative choice others are making.
I’m sorry you feel that way, but politics can be frustrating like that. That doesn’t make you a liar or an ideological hack, and it doesn’t make me one either.
By the way, the two examples linked in your first email are really, really, weak. In fact, one doesn’t demonstrate your point at all, it demonstrates the opposite. If I have time and the mood, I’ll address them in a later post.
Universal Coverage: One Man’s Story // Aug 23, 2009 at 4:34 pm
[...] Smith notes that the United States already has a universal health care system called “show up at the [...]
ottovbvs // Aug 23, 2009 at 5:19 pm
Brad Smith // Aug 23, 2009 at 3:54 pm
1. Broadly correct 2. Perception is reality…. if these people don’t think they have insurance they are going to avoid doctors and emergency rooms like the plague because emergency rooms are very expensive 3. largely guesswork many are legal and should be covered 4. They have no insurance for whatever reason 5. They have no insurance for whatever reason 6Balance; they have no insurance …….So what we actually end up with is about 10-12 million people composed of illegals and those who qualify but think they don’t…..I wouldn’t disagree with this so we have about 35 million people without insurance…….hardly an insignificant number and given that about 6.7 million people have lost their jobs since the start of the recession and many small firms have had to pull insurance I suspect the start point is nearer 50 million than 45 (Wellpoint’s enrollments alone were down about 350,000)
” So while most of them (most of us, really, as I’m in this group) do want to help the uninsured, most do not want to do so at the expense of damaging what is good about their own insurance. ”
………..Although this as essentially a Phariseeiacal attitude it’s not even true…..how is extending healthcare to others going to damage theirs?……it’s not…….And being happy about your care hardly takes account of the huge angst that exists amongst Americans who are concerned they might lose that healthcare they are so happy about.
………..All this is in any case largely moot since I have little doubt we’re going to see passage of a major bill almost certainly on recon that will look much like the President’s original wish list……perhaps we should check back in late November and see
ottovbvs // Aug 23, 2009 at 5:26 pm
Brad Smith // Aug 23, 2009 at 4:07 pm
“One way in which it is superior to almost every other country is that it keeps the size of the state smaller. Now, you may not consider that a value. But some of us do. I rank freedom and limited government quite high as a value. ”
…………Perhaps that’s why it costs twice as much as everyone else’s…..since you think there’s a causal link between the level of state involvement and the overall quality of the system it would follow that if we reduce the state’s role even further the cost will go even higher
“Once we move beyond that, we know that the U.S. is, in fact, superior to almost every other system in at least some ways.”
…………Perhaps why we rank 37th I think on the OECD list……I’ve personally been treated by the UK and French systems (I lived in both countries for several years) and the UK was satisfactory while the French was quite equal to the US…….you need to get out more
balconesfault // Aug 24, 2009 at 5:14 am
“One way in which it is superior to almost every other country is that it keeps the size of the state smaller. ”
Thus, our superiority would be increased even more were we to eliminate Medicare? To no longer provide S-Chip? If we eliminated our system of VA hospitals and Military Hospitals providing healthcare to retired veterans, and outsourced those services to private insurance?
All would significantly reduce the size of the state involvement in healthcare.
Brad Smith // Aug 24, 2009 at 8:32 am
Wow, I’m surprised by the inability to appreciate the idea that things have costs, and they have benefits. See, one benefit of a great big SUV is that it has lots of room for people and stuff. From this it does not follow that an even bigger SUV would be better (though it would have even more room for people and stuff). Or one might say that a small car is better, because it gets better mileage and is cheaper to insure and pollutes less. But from that it does not follow that we must get an electic smart car. The point I was making is that every system has its strengths and weaknesses. Because I place a high value on freedom and limited government, I will tend to favor solutions that promote freedom and keep government small – all else equal. Purely on the freedom scale, yes, eliminating Medicare is a benefit – just as, purely on the enviromentally awareness scale, getting a Smart Car is a benefit. But of course there are costs, too – the Smart Car isn’t so smart for hauling people or stuff, and its a real problem when it gets hit by a 4500 pound pick up truck. Eliminating Medicare or VA hospitals also has a cost. See, that’s cost/benefit analysis. You add up your costs, you add up your benefits, you compare.
Why do I bring this all up – because people such as Sparty and Otto in these posts simply cherry pick a couple numbers and say, in essence, “see other countries systems are better, so we should adopt them.” (By the way, Otto, if you’re still out there, I again suggest you quit writing as if you think you know me. I’ve lived on (and been treated medically in) three continents, travelled on 5. As Jimmy Buffet used to sing, “don’t try to describe the ocean if you’ve never seen it.”) My point is that assuredly by some measures every other nation’s system – even Zimbabwe’s – can probably be found to be better than ours. It is certainly worth looking to Canada and Britain and France and Switzerland to see what seems to work and what doesn’t, what are the costs and benefits they have found in practice. But you cannot just assert, as Sparty does, that everyone who disagrees with you is “uninformed” or an “ideological hack” because obviously it’s all hunky dory in other countries.
Universal Coverage: One Man’s Story - Hip Hop Republican // Aug 24, 2009 at 11:43 am
[...] Smith notes that the United States already has a universal health care system called “show up at the [...]
Bulldoglover100 // Aug 24, 2009 at 11:53 am
Actually Brad you need to get your facts straight and use some polling company besides Resmussen which has lost all credibility other than the Fox News group.
A majority of Republicans polled last week said they endorsed Universal health care…as ddid a majority of people in this country when they kicked the Republicans out of office last November.
ottovbvs // Aug 24, 2009 at 8:03 pm
Brad Smith // Aug 24, 2009 at 8:32 am
“Why do I bring this all up – because people such as Sparty and Otto in these posts simply cherry pick a couple numbers and say, in essence, “see other countries systems are better, so we should adopt them.” (By the way, Otto, if you’re still out there, I again suggest you quit writing as if you think you know me. I’ve lived on (and been treated medically in) three continents, travelled on 5. As Jimmy Buffet used to sing, “don’t try to describe the ocean if you’ve never seen it.”) ”
…….And this guy’s a university professor?……. where?….. some third rate education mill ?……. Oral Roberts…. Regent?…….thank god I spent a ton of money sending my kids to Ivies
Brad Smith // Aug 24, 2009 at 9:39 pm
Bulldog,
The proof is not in the polling, but in the electoral results. I agree that abstractly, people like the idea of “universal care.” But when they get serious about the tradeoffs involved in bringing it about, it leads to electoral fiasco, dating back to Truman and the Republican takeover of Congress in 1946 and again in 1952.
By the way, I’ve not even seen a Rasmussen or Fox poll that I know of. Again, I don’t understand why so many people can’t just respond to the arguments made, but feel some need to project.
Otto, comment 20, that’s a good argument. You are one sharp cookie.
Brad Smith // Aug 25, 2009 at 8:56 am
Dear Otto,
I went to the Ivies. Oh no – your kid could turn out like me!