[lbo-talk] citizens & SP

[Marvin Gandall]

State health plans can coexist with employer plans the same way private
pensions supplement Social Security. This is the case in Canada, where major
employers offer supplementary health care for medical expenses not covered
at all or covered inadequately by provincial health insurance plans
subsidized by federal transfer payments. I don't understand why
employer-paid and public plans are being so sharply counterposed to each
other in relation to the US, and why it isn't accepted that political
advances can be sought simultaneously in each arena, ie. ensuring mandatory
private coverage by all but the very smallest employers based on a
percentage of payroll, and expanding the existing state-run Medicare and
Medicaid plans.

Obviously, as Nathan, John and others have pointed out, the pace and scope
of expansion in both sectors will largely depend on the relationship of
forces - how strongly the working public and its organizations fight for
these improvements and how much resistance is offered by corporate America,
which, all things being equal, would rather the public saved for its own
health and retirement needs through individual tax-sheltered investment
accounts. It seems to me it's not possible to predict where breakthroughs
will occur first - any more than unions can predict with certainty where and
how much movement there will be on the range of their demands at the
bargaining table -  which would suggest that any and all motion to insure
better private and public sector coverage for larger numbers of Americans is
worthy of support.

I don't know that the two objectives are in contradiction to each other -
that the fight for more widespread employer-paid coverage subverts the push
for a single payer system (actually multi-payer since the federal,
state/provincial and municipal levels all share the burden of public
expenditures on health care). It's equally possible that the more the
private sector is forced to improve its coverage, the more it will seek to
offload the burden on government(s). This presupposes, of course, that the
Bush administration's proposal for individual health savings accounts proves
a futile bid to siphon off American public pressure for improvements to
these external sources of support.

Or is there something in particular about the US health care system and the
fight to reform it which I'm missing which makes drawing on the Canadian and
European experience invalid?