Single-Payer National Health Insurance

Jim Westrich westrich at
Wed Aug 25 07:08:42 PDT 1999

At 06:40 PM 8/24/99 , you wrote:

>Universal coverage does not require a single payer solution - it is
>possible to attain by means-tested public subsidies of insurance premiums.
>That is, you buy your insurance from a market vendor, and if you cannot
>afford one - government subsidies will make up the difference between what
>it costs and what you can afford.

There are a lot of things to say about this.

First, universal coverage is a worthy and progressive goal. Second, Wojtek's scheme would do some good.

But, your suggestion is largely the strengths of the Clinton plan (without all the unnecessary tiering and formulas). It has problems. You seem to dismiss the importance of cost controls as if that was not a progressive concern. It very much is. I cannot go into the argument completely here but other social factors determine how healthy a person is, so government resources drained away from education, job training, housing, child rearing, income expansion, etc. causes dis-ease. This dis-ease would then be treated in the health care sector. This at the extreme leads to some medical dystopia.

While I definitely think we should increase many areas of public health spending, the best public health measures are basic progressive ideals: peace, bread, work, and freedom.

I also disagree that his plan would work on equity grounds. Creating one system for the poor and another for everyone else to aspire to would lead to neglect of the public system and/or loopholes in its administration. All you have to do is look at Hawaii (which has had exactly the system advocated above and yet has high rates of uninsurance and the highest rates of underinsurance (crappy, nearly meaningless coverage) in the U of S of A.



"''Hey, Hey!' The donkeys say: 'Milk and honey's on the way' . . .

It's jam tomorrow, shit today." -- Ian Telfer

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