Tens 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, Republicans should not endorse universal health insurance coverage. Those who qualify for Medicare or who have employer-sponsored health insurance are getting a good deal — often a great deal — from the current system. There is no way to move from the current system to a system where everyone is insured without cutting back on their benefits and thereby angering them considerably. Alas, the same goes for various proposals to make individual health insurance more affordable, such as eliminating the income tax exclusion for employer-sponsored health insurance, or eliminating state health insurance mandates. The very irrationality of the current healthcare system — like the irrationality of current farm policy — keeps it in place. Let Democrats take on the political risks of reform.
In the meantime, Republicans have no choice but to endorse universal healthcare access, for that is the system we already have. Virtually all hospitals are required to provide emergency medical care regardless of ability to pay. Thus, everyone within reach of a hospital already has access to healthcare. If Republicans must come up with healthcare reform proposals, they should avoid the question of expanding health insurance coverage altogether. Instead, they should propose to expand healthcare access through direct subsidies to healthcare consumers. Qualifying citizens would under such a proposal receive vouchers that could be applied directly towards medical expenses. If Republicans are feeling bold, they can even propose to pay for the program by means-testing Medicare, or cutting the tax exemption for employer-provided health insurance. In any case, for Republicans finding ways to expand health insurance is a fool’s errand.
To read other contributions to this symposium, click here.
3 responses so far
1 NM Symposium Part 2 Universal Coverage: Right Goal, Wrong Principle? // Aug 25, 2009 at 4:41 pm
[...] Bramwell, Universal Coverage: We Have to Build on What We’ve Got There is no way to move from the current system to a system where everyone is insured without [...]
2 SFTor1 // Aug 25, 2009 at 5:52 pm
Does anyone have any data on the effectiveness of semantics on life-threatening diseases?
Mr. Bramwell seems to think it’s pretty potent stuff.
He also seems to share Emperor Nero’s enthusiasm for fiddling, this time while health care costs are burning a hole in our collective pocket.
3 sinz54 // Aug 26, 2009 at 10:35 am
“they should propose to expand healthcare access through direct subsidies to healthcare consumers”
The problem is that it’s tough to provide adequate subsidies on a “one size fits all” national level.
Health care costs, and health insurance costs, vary tremendously across the nation. Massachusetts has some of the most expensive care–but also some of the best care, with a world-class medical complex that treats patients from around the world. Other states like the Deep South have much cheaper care.
So a “one size fits all” yearly subsidy of say $5,000, which some conservatives have proposed, might be adequate for the South but totally inadequate for Massachusetts, where health insurance for a family of four can cost $12,000 a year.
But if you allow each household a tax credit equal to their health insurance premiums, you will just contribute to skyrocketing health insurance premiums unless you impose the kind of cost containment that conservatives won’t like.
And if you don’t allow each household a tax credit equal to their health insurance premiums but instead impose a flat ceiling of say $6,000, in effect you will be sticking Americans in states like Massachusetts and New York with a huge tax hike.
Bottom line: It doesn’t matter WHO pays for it. The question is how to reduce the costs of IT in the first place.
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