The Washington Post
September 16, 2003
Proposals for Expanding Health Care Coverage
By Julie Ishida
While the uninsured are left to deal with the consequences of being uninsured, policymakers have designed a variety of proposals to expand access to health insurance. The majority of Americans polled in a 2003 survey by the Kaiser Family Foundation and the Harvard School of Public Health support increasing the number of people in the United States covered by health insurance, but there is no consensus on how to accomplish this.
Karen Davis, president of the Commonwealth Fund:
“The proposals that are now being talked about are more pragmatic and less ideological and more focused on building [on] what works currently. How can we find out what’s working now and add more people?”
Paul Ginsburg, president of the Center for Studying Health System Change:”The reason why individuals are uninsured differs so much that it is unlikely that a single provision is going to cover them all. We need different approaches for different segments of the population.”
Here’s a summary of the major approaches under discussion.
Universal Coverage Proposals:
* Single payer
* Employer mandate
* Individual mandate
Incremental Proposal:
* Expansion of Medicaid and Children’s Health Insurance Program (CHIP)
eligibility
* Subsidization of private insurance
* Creation of a system similar to the Federal Employees Health Benefits
(FEHB) Program
http://www.washingtonpost.com/wp-dyn/articles/A15812-2003Sep15_2.html
Comment: The messages of individuals such as Karen Davis and Paul Ginsburg have dominated the national dialogue on health care reform. They imply that only piecemeal measures are feasible.
But the failure to control increasing costs, combined with a failure to reduce the numbers of uninsured have created an awareness that we need a more aggressive approach toward reform.
The recent publicity surrounding the physicians’ proposal for national health insurance published in JAMA, and the administrative efficiency achievable by a single payer system published in NEJM, have regenerated an interest in looking again at truly universal models of health care coverage.
Washington Post reporter Julie Ishida exemplifies the changing dialogue as she now includes universal models in her list of proposals. Members of the media understand the need to broaden the debate. But we need to convince the leaders of those organizations which support comprehensive health care coverage that it is once again okay to discuss universal systems of reform.Davis and Ginsburg need to hear that message.
One more message that we need to deliver is that there are very fundamental differences between the single payer model of social insurance and other so-called universal proposals. As an example, SB 2, California’s employer mandate which passed last week (but not yet signed by Gov. Davis) will still fail to provide coverage for over four-fifths of those currently uninsured.
It will significantly increase costs because it fails to eliminate the administrative excesses and fails to provide any significant cost-containment features. It also represents flawed tax policy since it is regressively funded, providing tax advantages for the wealthy and a lower net cost of their coverage, a benefit not available to low income individuals. It falls so far short of single payer goals that it is inappropriate to consider it in the same general category of reform.
Let’s convince our policymakers that it is time to put everything on the table. But let’s also convince them that single payer needs to be in a special place on the table wherein the policies of all other models are challenged to meet the golden standard of a universal, single payer system of social insurance.