The American health insurance regime is a mess. Many of us have seen Michael Moore's Sicko, which focuses on the greed and cruelty of the insurance industry -- specifically the ways in which companies screw policy holders by denying coverage for critical procedures and squirreling out of payments.
Sicko doesn't touch on another more boring but equally troubling problem, "adverse selection". Under our current system, the healthy, the young and the cash-strapped often gamble with their health by either not buying insurance or buying crappy insurance. Obviously, these folks are screwed if they fall ill or are injured. But the fact that these healthy people aren't participating in the risk pool also makes health insurance all the more expensive for everyone else, including the less healthy.
Plans for health care reform are now en vogue with liberal wonk types and this is a good thing. Following John Edwards' lead, the major Democratic presidential candidates are all peddling plans (mostly modeled on the Edwards' plan) that are supposed to move the country toward a system universal health insurance. A key feature of the Edwards plan is the personal mandates component, which would require adult individuals to buy health insurance (with government and/or employer support) just as car owners are required to buy auto insurance. This would effectively eliminate the adverse selection problem. People would be allowed to choose between a variety of insurance providers including a public plan based on Medicare. Edwards campaign material reads: "Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan" (the hope, of course, is that is does).
But isn't this needlessly complicated? The fact that it would become illegal not to buy insurance will be spun as statist authoritarianism and the transitional phase, in which private plans would be competing with the Medicare-type plan, would give the right a long window of opportunity to derail and sabotage the plan.
For both ideological and practical reasons, I think progressives should push for the existing health insurance system to be replaced by a single-payer system in one fell swoop. Ideally, monthly premiums would be eliminated and we would pay for this universal insurance through progressive taxation. Liberals who think this is too radical need to understand that right-wing opposition to any reform will be no-holds-barred and that we might as well stake out the most progressive position before considering any compromise. That's a key strategic principle of bargaining, isn't it? After all, the left has a very strong hand on this issue and there's no reason to underplay it.
It should come as no surprise that the first North American universal health care system was a socialist accomplishment. Canadian Medicare (that's what they call it up there) is modeled on the plan implemented by the Cooperative Commonwealth Federation/New Democratic Party government of Saskatchewan in the early 1960s. Those poor Canadian pinkos had to fight the great Saskatchewan doctors' strike, an AMA-backed rebellion of medical professionals. The history of that struggle should give us some sense of the steely resolve it will take to win health care for all in the United States.
Rowan Webb : http://financesmarter.com.au/blog/