Universal Coverage: A Fait Accompli

As other contributors have pointed out, our current system of universal coverage is called: “show up at the emergency room.” So as long as everyone is promised some level of insurance—emergency visits—why not have everyone pay?

Tens of millions of Americans lack health insurance. Extending coverage to them has been a core goal of health reform proposals since the 1960s. President Richard Nixon offered a universal health plan in his first administration, but since then Republicans have hesitated to commit the nation to so costly an undertaking. Is it time to rethink? Should Republicans accept universal coverage as a goal?  We posed this question to NewMajority's contributors.

 

 

It seems to me that the Republican Party—along with the rest of the country—has long endorsed universal coverage if not in name, then at least in fact.

 

As Frum Forum contributors Bradley Smith and Eli Lehrer rightly pointed out, our current system of universal coverage is called: “show up at the emergency room.” (Bradley’s words). Whether rightly or wrongly, we have decided that it is a moral imperative to treat emergency patients regardless of their insurance standing.

 

So as long as everyone is promised some level of insurance—emergency visits—why not have everyone pay?

 

Newt Gingrich is right; we should have a “300 million payer” system.  The government should mandate a minimal insurance program that covers hospital treatment—the small payments will not cover the emergency room costs, but they will help our indebted system to an extent, and they will have the added benefit of making all citizens conscious contributors.

 

More expansive insurance plans should be operated by private companies that are allowed to compete across state boundaries.

 

This is not consistent with my theoretical principles—the decision to buy or not buy should be left entirely to the individual.  But through our self-imposed (and probably morally justifiable) requirement that we offer emergency services to all, we’ve already fallen off the libertarian road and onto a communitarian system.

 

Fortunately, this doesn’t have to go too far.   Auto insurance is now required, and we’re not yet living in a socialist or, as is now popularly suggested, in a “totalitarian” state…

 

Let’s rephrase the question. “Do we want de facto universal coverage in which only some people pay? Or do we want de jure universal coverage in which everyone pays while still preserving individual choice?”

 

To read other contributions to this symposium, click here.