Universal Health Care – The Briefing Book

In every political campaign (at least the good ones) there is a “book”. It outlines the issues for the candidate, and his/her arguments and positions.  It puts everyone literally on “the same page” when it comes to any issue.  I’m not running for office, but I am presenting a series of issues for my “briefing book.”

History

There is a great advantage in doing something for the first time, rather than a “do over.”  You can solve “the problem” before there are winners and losers.  Everyone has something to gain, no one is giving up something they already have.

Health insurance became an important job benefit during World War II.   As part of the War effort, the Federal Government froze wages.   Employers needed incentives to keep their limited labor supply, they found a new way to compensate employees:paid health insurance.  After the War its popularity grew and became a common part of rewarding employees.  Insurance costs were low for the companies and most employees were fully covered without paying additional fees.

As late as the 1980’s it was common for workers to be fully covered.  At that time, I remember an insurance conflict in my teacher’s union. Teachers with families at the same pay step were getting more compensation over single teachers.  Today it seems like a foolish argument, but back then; everyone was getting insurance for free and salaries in education were low; so being “fair” was a big deal.

Of course if you didn’t have a job, your insurance wasn’t covered.  If your income level was low enough, you were eligible for Medicaid.  If you were old enough, you were eligible for Medicare.  And if you were in between jobs, you could get expensive COBRA insurance.  Otherwise, if you were sick and ended up in the hospital, you were paying out of pocket,  or you were simply a “charity case.”

Costs Escalate

Health care costs increased. Part of this was because of the sophistication of modern medicine; an X-Ray, penicillin and an aspirin were no longer the medical answers for most problems.  With the amazing amount of tests, devices, medications, and treatments; someone had to pay for development, availability, and use.  And, of course, insurance companies were publicly owned, and wanted profits for their shareholders.

And as medicine got better, and people lived longer, they got more diseases.  End of life care became extremely expensive, and that cost was shared across the insurance buyers.

Employers found that the increasing costs of insurance were prohibitive.  They passed on the costs to employees, who had little choice but to pay. It was either that, or “go bare” and risk personal bankruptcy for even non-life threatening medical situations.

The Answers Today

Which brings us to the present.   Many Democrats look to some form of universal health care as the answer, paid through taxes to the government.  This has the advantage of having the biggest pool of insured members; everyone.  The young adult just beginning a career, the healthy thirty-something’s, the lucky fifty year olds who never get sick:  all would pay into the health care system and help cover the costs of the sick.  “Opt-out” is not an option, nor is “tailoring” a plan.  Just like those single teachers who got less than the married ones, everyone pays in, and people that need benefits, get them.

This is little different than public education, or fire departments, or the armed services.  To call government run health insurance “socialism” is to deny all of the other public services that our governments provide; local, state and national.

  Just a note: Fire Departments used to be privately run businesses too – either you paid the company or they didn’t put out the fire.  Different companies would fight over who got what fire.  It wasn’t a good system for our cities, the town could burn down while the firemen brawled.  What’s burning down now??

So the easy answer is to switch over to government run health care.  But there’s a problem.

Americans Who Got It, Like It

First is the practical issue:  many Americans are quite comfortable with their current, private insurance. Moreover, many of those same folks are suspicious of government run plans.  While the Affordable Care Act helped millions of Americans get coverage, the botched roll out with overwhelmed online servers affirmed what many already believed, that the government would “screw it up.” And President Obama made the promise: if you like your doctor you can keep him.  That was true for those who remained on private insurance, but if they switched to the Affordable Care Act policies, if wasn’t necessarily so.   

But, almost everyone liked having insurance covering pre-existing conditions, and letting children stay on their parents’ insurance until they were twenty-six.  Most liked the increased “wellness benefits” required under the ACA, and many of the other requirements all insurers were mandated to offer.

The thought of additional government insurance intervention worries workers who gave up salary for health benefits. It also concerns those who can afford to buy “luxury” health insurance; they are afraid they are going to lose out on a government run program.   And insurance companies who will lose their profits are spending millions to lobby politicians and the general public of the “dangers of socialized medicine.”   

The Costs Grow

But what those opposed to more government involvement in health care ignore is that the costs are growing out of control.  Health insurance cost is rising at ten percent a year for many small businesses. They can’t pay it, and they can’t afford to pay their employees enough to buy it somewhere else.  Middle-income workers aren’t prepared to pay $20,000 or more for insurance a year, but if they are thrust into an individual market now, that’s the lowest likely cost.  The problem will only get worse if nothing is done; as more of the young and healthy “go bare” it makes the “insured pool” sicker, and therefore more expensive.

Solutions

The Republican Party has not offered a solution to the growing problem of health care costs.  They have promised to figure one out, somewhere, somehow.   Their advantage: with nothing on the table there is nothing to criticize.

Republicans and Democrats both agree that it’s past time to get control of the cost of prescription drugs. The “poster child” is insulin, with the cost going up 4000% in the past few years. The US Government gave away the ability to negotiate drug prices for Medicare and Medicaid, but they could legislate that power back.

Democrats are offering all kinds of health coverages.  The “moderates” like Biden, Bennett, and Delaney are all offer a “public option” in addition to the existing Affordable Care Act.  “Public Option” is a government run plan that those in the insurance market could choose to buy.  It wouldn’t impact those with private insurance.

Of course that means that the public option insured pool is likely to be sicker, and therefore more expensive to insure, than the “private pool.”   The cost of that expense would be shared across the government, taxpayers, rather than fully thrust on those insured.

And the more “progressive” Democrats want a total overhaul of the health care system.  They say it will create a lot more winners than losers, and that the winners will more likely be Democrats than Republicans (well, they don’t say the second part, but it’s probably true.)  What the total overhaul would do is make a serious effort to control medical costs, by removing the insurance company profits, controlling drug prices, and reducing the enormous paperwork required by everyone in the industry.

Right or Likely

That’s probably the “right” answer, but not the likely answer.  We are an America of moderation and incrementalism.  It is more likely that the moderate plans with public options will be the next step in government involvement.  Ultimately the controlled costs of government programs will overwhelm the private market, and America will make a de facto decision to use a government run health system.  But it will take time, not the “Revolution” called for by the far left of the Democratic Party.