Covering the Uninsured: Options for Reform

Kaiser Family Foundation
September 17, 2008

Options for Covering the Uninsured

1. Build on the current system:
Strengthen the employer-based system
Expand public coverage by building on Medicaid and SCHIP
Create new group insurance options for individuals and businesses

2. Revise the sponsorship and financing of health coverage through the tax system

3. Adopt a single-payer plan

Listening to the national dialogue on health financing reform, you would think that we have only two options: 1) Don’t start from scratch with a better program, but build on the current system (Obama), or 2) Reform the tax code to shift incentives for purchasing insurance from employers to individuals (McCain). Replacing our dysfunctional financing system with a single payer national health program, if even mentioned, is immediately dismissed from the dialogue.

As an example, yesterday Health Affairs released three new articles commenting on the reform proposals. An excellent article by Buchmueller et al explained why the McCain proposal would be relatively ineffective in expanding coverage to more individuals and would likely result in a deterioration of the effectiveness of health plans. An article by Antos et al explained why the Obama proposal will fail to slow the escalation in health care costs, besides falling short on universal coverage.

The third Health Affairs article should have been on how single payer would control costs while providing comprehensive coverage for everyone. It wasn’t. Instead it was an article by Mark “Moral Hazard” Pauly describing a compromise model incorporating features of the McCain and Obama plans. Although the Buchmueller and Antos articles were covered extensively by the media, I couldn’t help but notice that the Pauly article was ignored, and quite appropriately so.

Kaiser Family Foundation is precisely right. There are three options for reform. We know that only one of them will work: single payer. A discussion of the McCain and Obama plans is not complete without including an explanation of the effectiveness of single payer. It’s our job to be sure that it is included.