By Annette Fuentes
September 19, 2007
When it comes to protecting our children’s health, where does the federal government’s role end and the responsibility of families begin?
Both houses of Congress want to expand health care coverage of low-income children under the State Children’s Health Insurance Program (SCHIP), which expires at the end of this month. Most members of Congress are concerned that more and more low-income children are falling into the growing pool of the USA’s uninsured, most recently estimated to be 47 million.
But President Bush says expanding the program could encourage families whose children are covered by private health insurance to opt for the government-paid program. Bush says he will veto any bill that would increase the number of children eligible because it would be another step toward a nationalized health care system.
But what’s wrong with such a system?
While the president and his supporters try to scare voters away from the idea of a national health care system, calling it “socialized medicine,” why shouldn’t all ideas be on the table for discussion?
The political skirmish over SCHIP is a microcosm of a larger debate this country needs to have over the direction of national health care reform as we head into the 2008 presidential election.
Put aside politics
Any discussion should begin by acknowledging that the USA already has a national health system: Medicare. The program has been an unqualified success as a government-subsidized and -administered health insurance system.
Ida Hellander, executive director of Physicians for a National Health Program, a non-profit that supports a single-payer approach, notes that Germany was the first to have a national health system early in the 20th century. U.S. conservatives in the post-World War I era attacked proposals for a U.S. national plan by linking it to the former enemy. “The way conservatives scared people off was to call national health ‘the Kaiser’s plan,’ ” Hellander says.
But two “allies” with national health care plans are worth noting:
* Great Britain guarantees all its citizens coverage, paid for by taxes and delivered by doctors employed by the health care system. According to the World Health Organization, the United Kingdom spends 6% of its economy on health care and ranks 18th out of 191 countries in health system performance. The United States spends 16% of its economy on ours, but we rank 37th, a step ahead of Cuba.
* Canada has a single-payer system that guarantees every Canadian coverage. It’s paid for by tax dollars. The government pays all claims, so there is no private insurance industry acting as middleman to administer the system. That’s where the big savings come. In Canada, administrative costs are less than 17% of all health spending, compared with 31% in the USA.
But the Canadian system does have one drawback: Its citizens face somewhat longer waits for some care — such as seeing specialists, receiving MRIs and non-emergency surgeries — than Americans.
In recognition of the high priority Americans place on health care reform, the leading U.S. presidential candidates have at least paid lip service to addressing their concerns, with the Democrats articulating more developed ideas.
On the Democratic side, only long-shot Rep. Dennis Kucinich of Ohio supports a single-payer system. Many use the term “universal health care,” which means that everyone would be covered in some fashion, including through public programs such as Medicare and SCHIP or private insurance plans. John Edwards would require employers to provide coverage or financial assistance, and he would expand public programs such as Medicaid and SCHIP. He also would create regional purchasing pools to make health insurance more affordable. Sen. Barack Obama, D-Ill., calls for a “new national health plan” with guaranteed eligibility and a federal subsidy for those who can’t afford to buy into the new plan. Sen. Hillary Clinton, D-N.Y., proposes a universal health care system that would cover all the uninsured, in part by expanding SCHIP, and that would make health insurance more affordable and protect coverage of those with chronic illness.
Of the Republican candidates, Rudy Giuliani proposes up to $15,000 in tax deductions for families to buy health insurance. Sen. John McCain, R-Ariz., has no plan other than to create “affordable” health insurance without added government spending. And Mitt Romney, who as Massachusetts governor implemented a mandatory universal health insurance plan, now opposes the same approach for the nation. Instead, he supports tax incentives and market reforms to lower costs.
There could be drawbacks to a single-payer system, but there are more good reasons to consider just such a system. We need an open, honest discussion of all possibilities without fearing the bogeyman of nationalized health care. With broad popular support for reform, maybe the debate will yield actual change when a new administration moves into the White House.
Annette Fuentes is an adjunct professor at the Columbia University Graduate School of Journalism and a member of USA TODAY’S board of contributors.