Universal Coverage: We Have to Build on What We’ve Got
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.
No, Republicans should not endorse universal health insurance coverage. Those who qualify for Medicare or who have employer-sponsored health insurance are getting a good deal -- often a great deal -- from the current system. There is no way to move from the current system to a system where everyone is insured without cutting back on their benefits and thereby angering them considerably. Alas, the same goes for various proposals to make individual health insurance more affordable, such as eliminating the income tax exclusion for employer-sponsored health insurance, or eliminating state health insurance mandates. The very irrationality of the current healthcare system -- like the irrationality of current farm policy -- keeps it in place. Let Democrats take on the political risks of reform.
In the meantime, Republicans have no choice but to endorse universal healthcare access, for that is the system we already have. Virtually all hospitals are required to provide emergency medical care regardless of ability to pay. Thus, everyone within reach of a hospital already has access to healthcare. If Republicans must come up with healthcare reform proposals, they should avoid the question of expanding health insurance coverage altogether. Instead, they should propose to expand healthcare access through direct subsidies to healthcare consumers. Qualifying citizens would under such a proposal receive vouchers that could be applied directly towards medical expenses. If Republicans are feeling bold, they can even propose to pay for the program by means-testing Medicare, or cutting the tax exemption for employer-provided health insurance. In any case, for Republicans finding ways to expand health insurance is a fool's errand.
To read other contributions to this symposium, click here.