"To a growing number of major employers", says Donlan, "the prospective benefits of a national health-insurance system are starting to outweigh the costs...Ford and General Motors are joining the United Auto Workers union in support of the idea...This is a new way of looking at the health-care issue - not as a crusade to extend a new right to all Americans, but as redistributing a huge burden that makes U.S. industries less competitive...Saving ourselves by saving employers by creating a national health-care system could become an unstoppable movement."
Interesting also is Donlan's observation that the state-by-state movement for mandatory employer coverage has given Wal-Mart and other employers "with less-than-generous health-care benefits...a reason to look at national health insurance." This ties in with the current "stagist" emphasis of the US labour movement, whose views Nathan Newman represents. But the column also points to the wide circulation the single payer concept is already receiving, including within the corporations, indicating that it perhaps is, as Nathan's critics contend, an idea whose time has come. Frankly, it's still not yet clear to me whether these ideas are complementary or contradictory to each other, and we may need to watch both processes develop a little further - they appear to be unfolding rapidly and simultanously - before drawing any definitive conclusions. ================================================== An American Solution We can build a system of universal health care, one person at a time By THOMAS G. DONLAN Barron's March 20 2006
CAN THERE BE SUCH A THING as a universal, affordable, high-quality health-care system? Most realistic analysts say you can have any two of these attributes, but not all three. Others say the realists are actually optimists: It's hard to imagine a system with more than one.
Most universal systems are unaffordable in the long run to the economies that support them. A slow decline in quality is the natural result. In most of Europe, the long run has arrived.
Even many nonuniversal systems, such as America's Medicare, Medicaid and Veterans' Administration systems, face long-run financial and quality crises -- unless the taxpayers who foot the bills are willing to pay a lot more to keep them going.
Most affordable systems aren't universal: They can't cover the most expensive illnesses or the cost of long-term care for the aged. Or they scrimp on the quality or timeliness of the care, or both.
Quality, anyway, is in the eye of the beholder: Health-care systems everywhere fudge their self-imposed standards of quality to cover more people or to lower prices.
At a more basic level, each of these high-sounding values has a flip side: Universal also means compulsory; affordable also means price controls; high-quality also means highly regulated.
Assuming we want universal, affordable, high-quality health care, do we really want a compulsory, price-controlled, highly-regulated health-care system? Aren't we already too close to that?
In the abstract, universal, affordable, high-quality health care is an obvious political winner, and so the 20th century saw seven major presidential efforts to enact an American plan:
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Can't we imagine another system -- a system in which we pay directly for what we get and know what we are getting?
Some say they have one. A single-payer system of national-health insurance pays all charges. Even simpler, a national-health service can own all health-care institutions and employ all health-care providers. In these systems, citizens pay the government to make all health-care decisions for them.
To a growing number of major employers, the prospective benefits of a national health-insurance system are starting to outweigh the costs. Ford and General Motors are joining the United Auto Workers union in support of the idea. They have noticed how much less of a health-care burden their Canadian employees and retirees are than their U.S. employees and pensioners. The latest round of auto-factory closings will hit Michigan much harder than Ontario.
Meanwhile, the Maryland state legislature recently gave Wal-Mart a reason to look at national health insurance, by passing a law to force the giant retailer to provide more generous health benefits. Other states are considering similar action, and if it becomes a trend, all employers with less-than-generous health-care benefits will see that they could be next.
This is a new way of looking at the health-care issue -- not as a crusade to extend a new right to all Americans, but as redistributing a huge burden that makes U.S. industries less competitive. As such, it is also gaining new adherents in small business, where health care's share of labor cost often drags down the creation of new and productive jobs.
Insured Americans never have cared much about the uninsured -- that's why six out of seven health-care movements never took hold. But every troubled company starts its restructuring by raising health-insurance charges and cutting retiree health care. Saving ourselves by saving employers by creating a national health-care system could become an unstoppable movement.
It is possible that 16% of U.S. GDP is enough to finance a British- or Canadian-style system without the drawbacks. But that's not the way to bet. A universal national health system still will be unlikely to be affordable and offer high-quality care.
A better approach would be to return to the concept of individual medical insurance, making it universal by making it compulsory.
With hundreds of insurance companies competing for everyone's business, there would be affordable coverage styles for every budget. The federal government would buy basic coverage for those without means, but those checks should be its only contribution to the system.
Quality assurance could then be left to informed consumers wielding their own money in the market, the most powerful force in the world.
Americans have been properly cautious about national-health care schemes, but it's now time to build one, if we do it right.