Monday, September 05, 2005
Editorial: For healthier workers and a healthier nation
Sensible options exist to transform a ruinously expensive and inadequate medical insurance system into efficient, universal coverage.
From the RoundTable blog
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When the Clinton administration's health care plan went down in flames after Labor Day in 1994, universal medical coverage seemingly went down for good, too. The Republican Party soon took over Congress, followed in time by George W. Bush's two victories.
The proposal -- confusing, excessively complex and ineptly handled by the Hillary Rodham Clinton-led task force -- may have deserved its fate. But universal health coverage should not be consigned by association to the ash heap as well.
Pragmatic alternatives remain to the current fragmented, inefficient system, which provides less care for more money than in any other developed nation. Americans need not accept it as their lot.
Not the more than 45 million uninsured who either suffer needlessly or scramble to find charity care for themselves and their families. Not the millions more underinsured, and not the tens of millions who struggle to pay soaring premiums, deductibles and co-pays, and still could be ruined if illness coincided with a layoff or budget cut.
A variety of plans offer hope. So does the political and economic environment. Human decency still cries out for universal coverage, but now reform is also a vital infrastructure issue. Health care costs drain state and federal coffers, cripple small businesses and threaten the viability of corporate giants such as General Motors.
June's Washington Monthly outlined one proposal worth considering. Ezekiel Emanuel, an oncologist and Ph.D., and Victor R. Fuchs, a professor emeritus at Stanford University, propose a system of health care vouchers, paid for by a value-added tax, to buy a basic insurance policy for every American: doctors' visits, hospitalization, prescription drugs and catastrophic coverage.
Costs would be controlled and efficiencies gained by, among other things, replacing the present bureaucratic patchwork of employer-provided and government programs, including Medicaid and the Children's Health Insurance Program, and by establishing an independent oversight board similar to the Federal Reserve.
Emanuel and Fuchs estimate the total annual cost would be less than the $800 billion now spent for a system that leaves more than 13 percent of the nation without health insurance.
They emphasize flexibility and a continued reliance on the marketplace. Individuals and families would use their vouchers to buy minimum-level policies from private insurers. More generous coverage could be purchased if individuals wished to pay for it themselves. Choice of doctors and hospitals would be determined, as it so often is today, by the private insurance networks to which they belong, rather than by government fiat.
That's one possibility, scantily summarized. Other plans may deserve consideration if they meet criteria set by Emanuel and Fuchs:
n Coverage should be truly universal.
n It should pay for those now uninsured by cutting existing waste.
n It should control future cost increases.
n Consumers should have a choice of plans and doctors.
n It should result in less government bureaucracy and make the economy more productive.
Vouchers might be the answer. The present system is not.
