[Mb-civic] Toward true national insurance - Robert Kuttner - Boston Globe Op-Ed

[William Swiggard]

Toward true national insurance

By Robert Kuttner  |  November 26, 2005  |  The Boston Globe

IF YOU ARE a young adult, the parent of a young adult, a self-employed 
worker in the new economy, or one in a low-wage job, you are on the 
front lines of the health insurance crisis. Once, decent employers 
provided health insurance as a fringe benefit. But that fringe is 
unraveling.

If your employer doesn't provide insurance, good insurance is 
astronomically expensive to purchase. More and more young adults, 
convinced that they won't get sick, are just doing without. Politicians 
of all stripes are hearing from constituents.

The Massachusetts Legislature is again wrestling with this issue. Each 
of the three approaches in play -- the House bill, Governor Romney's 
plan, and the Senate bill -- bumps into unfortunate fiscal and political 
realities. The best approach, universal coverage with a single financial 
pool (Senator Warren Tolman's bill), is not even on the agenda.

Romney claims we can deliver decent family health insurance for $200 a 
month. That's fantasy. You can achieve that target only with very high 
out-of-pocket payments, or by severely restricting treatment options. 
Decent insurance for a family costs more like $600 a month. (That's why 
the working poor can't afford it.) The governor also likes an 
''individual mandate": Compel the uninsured to buy insurance; the poor 
would get subsidies. But individual insurance is the least efficient way 
to insure people.

The Senate approach would broaden coverage by shifting more 
out-of-pocket costs to consumers. Employers could join a state-sponsored 
pool that allowed very high deductibles and co-pays. This is politically 
attractive until ordinary people realize the consequences. As health 
policy it is a devil's bargain. The system is already shifting too many 
costs to sick people.

The House bill would genuinely expand coverage to nearly everyone, by 
requiring employers to either provide decent insurance or pay a new tax 
to finance state-provided insurance. This is the best of a bad lot, but 
it would retain our current fragmented system with its wasteful 
administrative costs. And predictably, it runs into fierce opposition 
from the business community as a whole.

House Speaker Salvatore DiMasi was quoted as wondering why businesses 
that provide health insurance give political support to those that 
don't. Mr. Speaker, it's called class solidarity. President Clinton ran 
into the same problem a decade ago, when he naively expected large 
corporations that hate government regulation to support universal heath 
insurance because it would save them money.

Health insurance is the most vivid case of what political scientist 
Walter Dean Burnham calls a ''politics of excluded alternatives." Polls 
consistently show that over two-thirds of Americans want universal 
tax-supported health insurance. Gallup found that 79 percent of 
Americans want coverage for all, and 67 percent don't mind if taxes are 
raised to pay for it. Fully 78 percent are dissatisfied with the present 
system. Medicare, the one part of the system that is true national 
health insurance (for seniors) is overwhelmingly popular.

There is no hotter political issue, nor one that strikes closer to home. 
So, if Americans overwhelmingly want national health insurance, why 
don't we get it? Three huge reasons: political, fiscal, and jurisdictional.

Politically, the immensely powerful private insurance industry would be 
displaced by national health insurance. Nearly all corporations would 
rather suffer with the devil that they know (escalating premiums) than 
the devil they hate (an expanded role for government). Ideologically, 
something supported by overwhelming majorities is seen as radical. (So 
was Social Security until it was enacted).

Fiscally, a shift to national health insurance would require about $700 
billion that currently goes through the private sector in charges to 
workers and consumers and shifted to the public sector in the form of 
taxes. The result would be a far more efficient and reliable system, but 
many voters would see the increased taxes but not appreciate the savings 
in premium costs, payroll deductions, or out-of-pocket charges.

Jurisdictionally, states like Massachusetts can perhaps make some 
piecemeal progress, but it's hard to do this right in one state without 
pushing the system toward further fragmentation. Medicare works because 
it's a national program.

The best first step would be public, universal coverage for everyone 
under age 25, a group relatively cheap to insure. That would be a big 
political step toward true national health insurance, because it would 
accustom working-age Americans to the value of a universal system. And 
if it works for our kids and our parents, why not for everyone?

Robert Kuttner, co-editor of The American Prospect, can be reached at 
kuttner at prospect.org. His column appears regularly in the Globe.

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2005/11/26/toward_true_national_insurance/
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