Towards Universal Health Care

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leetle hospital

Building health care, one tiny hospital at a time. [Wosog / Flickr]

Yesterday the Massachusetts legislature passed a bill that would make the state the first in the nation to mandate nearly universal health care coverage for all its residents. The plan pieces together coverage through government subsidies to private plans for the “working poor,” and tax penalties to businesses and private individuals who can afford care but do not purchase it. According to the Times, the plan is expected to cover about 95 percent of the state’s uninsured population within three years, and Governor Mitt Romney says he will sign the bill with gusto.

So is this new plan the start of something different? An attempt at full or nearly full care health coverage in the U.S.? Does the Massachusetts plan have the potential to be a national model, or at least a model for other states? According to The New Yorker’s Malcolm Gladwell universal health care in America has always been a popular idea without enough political traction to succeed.

Six times in the past century—during the First World War, during the Depression, during the Truman and Johnson Administrations, in the Senate in the nineteen-seventies, and during the Clinton years—efforts have been made to introduce some kind of universal health insurance, and each time the efforts have been rejected.

Malcolm Gladwell, The Moral Hazard Myth, The New Yorker, 8/29/05

The Massachusetts plan isn’t universal health care, but rather, near universal health insurance. Instead of talking about universal health care on the model of European countries and Canada, the new plan is more tied into notions of the “ownership society,” perhaps made even more palatable as a state initiative (rather than a federal one), and a bill introduced to a blue state legislature by a Republican governor with strong business ties (and possible national political aspirations).

So what do you think about Massachusetts’ new plan? Does it have the potential to work in your home state? Have the lines of debate about universal health care, re-drawn every generation or so, been redrawn yet again? What’s the difference in the conversation about universal health care and universal health insurance? And does this bill resemble a nail in the coffin of social programs enacted on a national level?

Brian Rosman

Director of Policy, Health Care For All

David Himmelstein

Associate Professor of Medicine, Harvard Medical School

Co-founder, Physicians for a National Health Program

Jonathan Cohn

Senior Editor, The New Republic

Contributor, TPM Cafe

Matthew Holt

Vice President of Research, Professional Service Solutions Inc.

Author, The Health Care Blog

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  • Jon

    A national treasure of this country has been our major university teaching hospitals. Yet for those located in the inner city or in other areas where the number of uninsured or underinsured patients has become quite high, the health not only of the patients, but also of these institutions themselves, is growing increasingly worrisome. Perhaps the Massachusetts plan is a model to improve the health of both entities? If so, it could well serve as an important national model.

  • Not a question as much as an observation. While a few pragmatic states are developing universal coverage type health care plans, Europe which has so often been revered for its national health systems is taking steps to dismantle them. Though the process has not yet kicked into high gear across europe, in many european nations such as the Netherlands where I moved to a few years ago, are in fact making changes that clearly indicate a movement towards a more american style system. (early stages) Ironic perhaps, over here they move slowly towards the broken private system, while over there they try to find ways to repair the damage.

  • cheesechowmain

    I often wonder why business leaders aren’t advocating more of this. Are they are afraid of the taxation boogeyman?

  • cheesechowmain

    What, if any, are the loopholes for business? How about some average gross numbers for large & medium? How much money will these firms save or loss compared to the current system?

  • hiringfiend

    I am a single woman who works as a contractor. So I have no employer. I have been very ill with arthritis and have only found relief with alternative remedies. I have no interest in Western medical care and am outraged that I will be forced to buy medical insurance that will not pay for what I need for treatment. Making it mandatory for me to buy into the insurance fiasco is not a solution to anything.

  • robin hood

    What about wellness? We will never afford if we keep waiting for people to get sick and then get care. Maintaining a healthy lifestyle is a personal choice that results in lower demand on the system. Does this bill promote healthy lifestyles?


  • thenfg

    For less than $300 any business can get out of providing health care. The actualy cost is certainly more than $300 (more like $2000-$3000). What is going to stop every business from dropping health care coverage?

  • nother

    Many people I know hide some of their assets in order to qualify for free care from MassHealth. What is the incentive for my friends and family to switch?

    Could we open up Masshealth, bring more people into that system?

  • cheesechowmain

    Trim the fat. Start with the insurance gluttons hogging the trough. Amen to David Himmelstein. Group coverage has turned into a boondoggle.

  • Matt_Eldridge

    Perhaps I’m just selfish; I’m healthy and don’t particulalry want to pay for the exhorbitantly expensive health care of people who are chronically sick. Particularly individuals who may be making very poor choices that effect their health. I might be more interested in universal health care if the medical industry did not charge private insurance more money for everybody’s services because medi-caid/care only pays about 60% of a given bill.

  • cheesechowmain

    Another angle on reducing costs and improving care: Internal Bleeding: The Truth behind America’s “Terrifying Epidemic of Medical Mistakes by Robert M. Wachter, M.D

    There are many simple measures that would improve care and reduce costs and insurance costs.

  • avecfrites

    I wonder if the Republican Federal Government will somehow try to intervene to stop it. I notice that California tries to tighten environmental rules, and is often overruled by the feds.

    Maybe the answer to lots of current problems is for states to stop waiting for the feds to go along with everything, and to solve problems for themselves. Maybe states could enter into informal agreements to share national guard units in the event of Katrina-like events. Or encourage cost controls on medical services resulting from the combined buying power of multiple states. Seems like an avenue to explore for contiguous like-minded states. Call it a virtual secession from the union.

  • fiddlesticks

    Great show, caught some of it while driving. Heard Matt’s question.

    My answer to Matt is that people don’t always choose to be sick and someone may do everygthing right and still end up on the operating table.

    You may be young, healthy, and wealthy right now, but life may some suprises instore even for you in the future.

    You yourself may end up needing affordable health care and the last thing you want to do is run into a Matt Eldridge when that happens, trust me.

  • reality_bytes_it

    I would suggest all read the post in the gutersnipe thread regarding the term “idealogical masterbation”.

  • Dwight McCabe

    You’re missing a huge point. The system is based on a fiundamental flawed design – competition between private payers (insurance companies) to avoid potentially expensive patients drives up the cost astronomically. Competition doesn’t make savings in this case, it causes huge duplication between the insurers.

    This not only results in all the bureaucracry in each insurer to screen out sick people but it creates all this red tape that doctors and hospitals and patients and businesses have to deal with. When one doctor has to have seven admins to handle the billing and chasing payments from insurers, something is wrong.

    The U.S. spends 31% of all health care spending on administration (for people under 65). Medicare and the VA, single payer systems, only pay 2%. Many studies have found that going to a single payment system, still with private care, we can cover everybody for the same or even less money.

    When a system is broken, band aids don’t fix it. You have to change the entire system.

  • You had MATTHEW HOLT on! I was so delighted when I flipped on the radio in the car this evening, and there was Mr. THCB himself. That blog is like Peyton Place Meets HMOs. His coverage of the HealthSouth scandal was amazing.

  • Carroll

    I would have to know the details of the Mass. plan to be able to give an opinion on it….

    But I can offer a few thoughts.

    First. the entire concept and working structure of Insurance is based on a “shared risk pool”. Initally insurance was based on the idea of the larger the risk pool (number of subscribers) the more resources provided to cover the subscribers.

    However, health insurance has morphed entirely away from the days of such insurers as the original non-profit insurers like Blue Cross once was, into for -profit outside stock holder coporations.

    This is “capitalism” gone astray if you believe that all people in a civil society deserve basic health care. Personally I don’t think you can call a society ‘civil” if it doesn’t offer a way for everyone to have access to health care.

    Another point is this….the uninsured directly contribute to the rising cost of health care. Hospitals are required by law to treat the uninsured. Most who use hospitals for emergency care aren’t able to or don’t pay their bills. This requires hospitals, and many doctors also, to charge more to the paying insured users, which in turn requires insurers to pay more, which then also raises insurance premiums for the insured as the insurance companies pass on those cost. Generally there is an enity in every state ( in my state it is Blue Cross) that acts as the authority for medical cost and determines what percentage of markup a hospital can charge paying users to cover the losses they take on the unisured. This is where the $5.00 asprin you get in a hosppital comes from. So, it is a vicious cycle of esculating cost, all falling directly back onto the insured…because the insurers are going to mantain their profits no matter what.

    So the uninsured are a problem in the cost factor.

    If you are very rich the esculating cost of insurance and medical care is no problem, if you are poor it is no problem except you most likely have no credit status if you have had legally required services and not been able to pay for them and generally you aren’t very healthy and if you have serious condition it goes unattended untill it is very serious. If you are middle class it is becoming a large problem to meet the high cost of insurance premiums and if you have a serious illness you can quickly be wiped out financially by something like cancer treatment for example.

    Also insurers use a ‘zip code’ system of pricing on medical services. If the hospital you use happens to be in Richmond Va. as opposed to Beverly Hills , they will pay less for the same service even if the service, quality of service and all things related to your treatment are identical…and even if your premium cost has been identical to the cost of a similar subscriber in Beverly Hills. As with car insurance you will pay almost the same amount for collusion insurance for a $9000 used car as a covered driver with a $30,000 car value.

    Some say the federal goverment model for federal employees is ideal..however not many taxpayers realize that they actually subsidize our federal workers and politicans health insurance with tax money from the general well as subsidizing their retirement fund…much like a company matches retirement saving and subsidizes employees insurance cost.

    I see only two ways to provide insurance and/or health care to everyone.

    Return to a non profit insurance model, deviod of stockholders to lower cost.

    Or institute mandatory universal health care through the existing Medicare structure already in place for retirees, with it’s low overhead, for the entire population which would constitue a universal risk pool.

    This could be done based on an income scale so that even the poorer would be paying some small amount and have access and could be capped at a certain rate for incomes up the scale…paid much as SS is now taken from wages automatically.

    Not to mention drug cost and Medicare D which is a total give away to drug companies and insurers and organization that offer drugs discounts for monthly fees. In addition to being the prelude to corporations doing away with employee benefits.

    Ford Motor company found that their factories in France were more profitable because they did not have to factor insurance cost into their labor cost.

    As things stand now workers are being squezzed from both ends….by employers seeking to cut their cost to enhance their bottom line and stock price by dropping benefits and by drug companies taking more profits in this country on their products than they can get abroad where providers negoitate for prices..and by insurers as they scramble to meet WS profit expections by increasing insurance cost.

    Something has to give. But it is unclear how that will happen. In this new facist type of capitalism the poor are only the first course in the meal….the second and third course will be those up the ladder as the feeding frenzy continues. It may be that the new capitalist will become extinct….like cannibals did, because they ate all their neighbors without planning or taking into consideration how they would reproduce their food supply…unfortunately by then, barring a revolution, a lot of people will dead drop outs from society.

  • DayLate

    As is evident by the tardiness of this posting, I believe that I chose my online name appropriately. First off, wow. What a fantastic show this was. Kudos to all who contributed! Second, I am brand new to Open Source, and brand new to online postings — aka “blogging.” In fact, this is the very first posting of any kind, anywhere for me. So to the Open Source community, I say unto you, please be gentle with me. But please DO correct me if I commit any blog faux pas. I wish to be a good online citizen! Moving on…

    I guess that my comment is really a question. It has to do with the notion of universal health care versus universal health coverage. In the introduction of the program, Mr. Lydon highlighted this distinction as what set the Massachusets plan apart from anything that has come before it. It got me thinking about what the difference really is. In countries with socialized medicine, when you go to the hospital, or see a doctor, SOMEBODY pays, right? Isn’t that “coverage?” Hmmm… truly, I need to learn more about the health care system in general. But even with that said, it is a question. And the next question should probably be, “does it really matter?” Is this just quibbling over semantics? Perhaps.

    I’ll be doing what research I can on my own, but if anyone has any thoughts on this, please share.

    Cheers, all!