| GMCarter 2005-06-13, 11:45 am |
| Krugman shines again!
George M. Carter
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http://www.nytimes.com/2005/06/13/o...krugman.html?hp
Op-Ed Columnist
One Nation, Uninsured
By PAUL KRUGMAN
Published: June 13, 2005
Harry Truman tried to create a national health insurance system.
Public opinion was initially on his side: Jill Quadagno's book "One
Nation, Uninsured" tells us that in 1945, 75 percent of Americans
favored national health insurance. If Truman had succeeded, universal
coverage for everyone, not just the elderly, would today be an
accepted part of the social contract.
But Truman failed. Special interests, especially the American Medical
Association and Southern politicians who feared that national
insurance would lead to racially integrated hospitals, triumphed.
Sixty years later, the patchwork system that evolved in the absence of
national health insurance is unraveling. The cost of health care is
exploding, the number of uninsured is growing, and corporations that
still provide employee coverage are groaning under the strain.
So the time will soon be ripe for another try at universal coverage.
Public opinion is already favorable: a 2003 Pew poll found that 72
percent of Americans favored government-guaranteed health insurance
for all.
But special interests will, once again, stand in the way. And the big
debate among would-be reformers is how to deal with those interests,
especially the insurance companies. These companies played a secondary
role in Truman's failure but have since become a seemingly invincible
lobby.
Let's ignore those who believe that private medical accounts -
basically tax shelters for the healthy and wealthy - can solve our
health care problems through the magic of the marketplace. The
intellectually serious debate is between those who believe that the
government should simply provide basic health insurance for everyone
and those proposing a more complex, indirect approach that preserves a
central role for private health insurance companies.
A system in which the government provides universal health insurance
is often referred to as "single payer," but I like Ted Kennedy's
slogan "Medicare for all." It reminds voters that America already has
a highly successful, popular single-payer program, albeit only for the
elderly. It shows that we're talking about government insurance, not
government-provided health care. And it makes it clear that like
Medicare (but unlike Canada's system), a U.S. national health
insurance system would allow individuals with the means and
inclination to buy their own medical care.
The great advantage of universal, government-provided health insurance
is lower costs. Canada's government-run insurance system has much less
bureaucracy and much lower administrative costs than our largely
private system. Medicare has much lower administrative costs than
private insurance. The reason is that single-payer systems don't
devote large resources to screening out high-risk clients or charging
them higher fees. The savings from a single-payer system would
probably exceed $200 billion a year, far more than the cost of
covering all of those now uninsured.
Nonetheless, most reform proposals out there - even proposals from
liberal groups like the Century Foundation and the Center for American
Progress - reject a simple single-payer approach. Instead, they call
for some combination of mandates and subsidies to help everyone buy
insurance from private insurers.
Some people, not all of them right-wingers, fear that a single-payer
system would hurt innovation. But the main reason these proposals give
private insurers a big role is the belief that the insurers must be
appeased.
That belief is rooted in recent history. Bill Clinton's health care
plan failed in large part because of a dishonest but devastating
lobbying and advertising campaign financed by the health insurance
industry - remember Harry and Louise? And the lesson many people took
from that defeat is that any future health care proposal must buy off
the insurance lobby.
But I think that's the wrong lesson. The Clinton plan actually
preserved a big role for private insurers; the industry attacked it
all the same. And the plan's complexity, which was largely a result of
attempts to placate interest groups, made it hard to sell to the
public. So I would argue that good economics is also good politics:
reformers will do best with a straightforward single-payer plan, which
offers maximum savings and, unlike the Clinton plan, can easily be
explained.
We need to do this one right. If reform fails again, we'll be on the
way to a radically unequal society, in which all but the most affluent
Americans face the constant risk of financial ruin and even premature
death because they can't pay their medical bills.
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