Universal Coverage? Universal Responsibility
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.
Republicans should favor universal responsibility for paying ones' own medical costs; that implies something similar to universal coverage. Uninsured Americans, of course, already receive medical care via emergency rooms, community health centers, and the like. Currently, however, the methods used to pay for such coverage are cumbersome, massively unfair, and tend to focus intellectual energy on cost-shifting rather than actually providing medical care. So long as medical ethics and federal law require the provision of medical treatment regardless of ability to pay--something that's not going to change--there needs to be some way of making sure that medical consumers pay their own costs. For the overwhelming majority of Americans, the purchase of medical insurance is the best way to pay costs. Individuals who affirmatively don't want health insurance or have enormous personal resources should be able to opt out of the system in return for either tax penalties (intended to cover the cost of care they are likely to receive anyway) or bond arrangements that show they can pay their own way. On balance, the Republican Party's core commitment to personal responsibility strongly suggests it should support something like universal coverage.
To read other contributions to this symposium, click here.