On Mar 18, 2006, at 3:24 PM, Marvin Gandall wrote:
> Below is quite a remarkable piece on America's health care crisis
> considering its source - Thomas Donlan, the very conservative
> columnist for
> Barron's financial newsweekly. Donlan loyally supports the Bush
> administration's proposal for individual health savings accounts,
> but his
> support notably lacks conviction. What is even more striking is his
> candid
> admission that the US could "finance a British- or Canadian-style
> (single
> payer) system without the drawbacks", with the resources currently
> directed
> towards the present patchwork arrangement of government-subsidized
> employer-paid health insurance plans.
>
> "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:
>
> [...]
>
> 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.
>
>
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