The New Republic and Universal Healthcare

The New Republic, an occasionally liberal magazine, once participating in the pilloring of Hillary Clinton over her healthcare initiative under Husband Bill. The editors now have repented of the error of their ways and admit that the American healthcare system is a disgrace and the only answer is some form of goverment-funded universal care. It is a good article; here is an excerpt:

Over the last 25 years, liberalism has lost both its good name and its sway over politics. But it is liberalism's loss of imagination that is most disheartening. Since President Clinton's health care plan unraveled in 1994--a debacle that this magazine, regrettably, abetted--liberals have grown chastened and confused, afraid to think big ideas. Such reticence had its proper time and place; large-scale political and substantive failures demand introspection, not to mention humility. But it is time to be ambitious again. And the place to begin is the very spot where liberalism left off a decade ago: Guaranteeing every American citizen access to affordable, high-quality medical care.

The familiar name for this idea is "universal health care," a term that, however accurate, drains the concept of its moral resonance. Alone among the most developed nations, the United States allows nearly 16 percent of its population--46 million people--to go without health insurance. And, while it is commonly assumed that the uninsured still get medical care, statistics and anecdotes tell a different story. Across the United States today, there are diabetics skimping on their insulin, child asthmatics struggling to breathe, and cancer victims dying from undetected tumors. Studies by the Institute of Medicine suggest that thousands of people, maybe even tens of thousands, die prematurely every year because they don't have health insurance. And even those who don't suffer medical consequences face financial and emotional pain, as when seniors choose between prescriptions and groceries--or when families choose between the mortgage and hospital bills.

These are not the sorts of hardships that an enlightened society tolerates, particularly when those hardships so frequently visit people who, as the politicians like to say, "work hard and play by the rules." Yet American society has tolerated this situation for a long time. It has done so, at least in part, because the majority of working Americans still had private health insurance, generally through their jobs--the consequences of losing health coverage were, for the most part, somebody else's concern. Universal health care promised them security they already had. Change would only be for the worse.

But how many people can really count upon such security now? Precisely because working people expect to get insurance through their jobs, they are dependent upon the enthusiasm of employers to help pay for it--an enthusiasm that is waning in the face of rising medical costs and global competition. Companies have responded by reengineering their workforces to shed full-time workers that receive benefits, by redesigning their insurance plans to offer skimpier coverage, or by simply declining to offer coverage altogether. Soon, the only employers left offering generous health coverage may be the ones forced to do so by union contracts--employers like the Big Three automakers, which, when we last checked, were barely skirting bankruptcy themselves.

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It's time for the government to be much bolder, to try something even more far-reaching than what it attempted in the '60s: making health care a right, not a privilege. And doing so for everybody, even if that means having the government provide insurance directly. Such a proposal might confound the conventional notions about what works and what doesn't work in public policy. But providing health insurance happens to be a job the public sector has already proved it can do very well. The most popular health insurance plan in the United States is Medicare--which, except for the drug benefit and a few HMOs that contract for the business, is a government-run health care program. And Medicare isn't only popular. It's also efficient. Nearly all of the money that goes into the program, via taxes and the premiums seniors pay, goes back out to purchase actual medical services. Private insurance, by contrast, inevitably diverts a much greater share of its premium dollars to administration, marketing, and profits, which means less money for the beneficiaries. In theory, insurance companies should be competing to provide their subscribers with the best, most cost-effective medical care. In practice, they compete over who can enroll the healthiest patients, since that is the surest way to improve profit margins.