Hillary Clinton, John Edwards, and Barack Obama all have essentially the same health plan. They all want to force everybody to buy health insurance, and none of them have a credible plan to cap or cut costs. The backdoor taxes they propose funnel a tremendous amount of money into the pockets of HMOs and do nothing to address the health care crisis in America.
When solving any problem, it always helps to begin by stating that problem clearly. Here's how our three leading candidates begin:
- Obama
- 47 million Americans - including nearly 9 million children - lack health insurance.
- Edwards
- The number of uninsured Americans has risen to 47 million
- Clinton
- ... ensure that all Americans have affordable, quality health insurance.
Notice anything? All three candidates are pitching a financial product, namely health insurance. The lack of health insurance in this country is not the problem. I seriously doubt that one of our collective goals as a society is to provide every citizen with a contract.
The goal, as I understand it from talking with actual people -- none of whom are, to my knowledge, candidates for office -- is to make our citizens healthy. The goal is to make our citizens uniformly healthy. The goal is to provide every citizen with high-quality health care. The goal, as I understand it, will not be achieved by any of the plans proposed by Edwards, Obama, or Clinton.
Statement of problem
Most Americans cannot afford basic health care services.
Example: Consider a family with a single child and working parents with an average income. They have health insurance through an employer, but the deductible is $1000 per year and the co-payment is $100 per visit to the doctor. The child has a mild case of asthma, which has already been diagnosed by a doctor, but the insurance plan requires a $20 co-payment for prescriptions and the child visits the doctor more frequently than other children, costing the family $100 each time. One of the parents suffers a back injury and the family is facing not only lost wages but also a year of expensive physical therapy, which isn't covered by their insurance.
What does Hillary Clinton's health insurance scheme do to help this family? In short, nothing. Sure, her plan offers everybody "the same menu of quality private insurance options that their Members of Congress receive," which is helpful if you make hundreds of thousands of dollars, as a Senator does, and you can afford the premiums. And, under her plan, "Americans who are satisfied with the coverage they have today can keep it" which is great, I guess, but doesn't help this family. There seems to be nothing in Clinton's plan which guarantees this family access to the health care they need at a price they can afford. The only thing guaranteed under Clinton's plan is that everybody will be forced to buy insurance. That's helpful to insurance companies, but not to working families.
What about Obama's plan? His plan is the same as Clinton's in all the essential points. Like Clinton, Obama "allow individuals and small businesses to buy affordable health care similar to that available to federal employees." Again, that's great, but we're talking about a plan which costs in excess of $20,000 per year per family. Offering this coverage to people without $20,000 to spare is not helpful. His plan also guarantees that "9 million currently uninsured children have affordable, high-quality health coverage" which is fine if you are interested in health insurance but we're talking about health care. Obama will also reduce "the costs of catastrophic illnesses for employers and their employees" which is a good start, but I think it's telling that employers come first in this sentence. And how, I wonder, will this help the unemployed, the elderly, children, and the self-employed?
Edwards plan is a carbon copy of the other two. I know Edwards talks a good talk about changing the rules of the game, but you only need to glance at his bullet points to find the essence of his plan. He will "require businesses and other employers to either cover their employees or help finance their health insurance." That's a great way to guarantee good returns on the shares of insurance companies, but it does not help deliver health care services. "Everyone will be expected to take responsibility for themselves and their families by obtaining health coverage," according to Edwards' plan. Let them eat cake, I always say.
The only major change under these three proposals is that people who are currently uninsured will be compelled by force of law to be insured, the same way we do with car insurance. I think that's a telling comparison. Today in America all drivers are required to carry compulsory insurance, but we still have uninsured drivers on the road. In fact, one in seven California drivers is uninsured, even after the compulsory insurance scheme has been in place for decades. We know, from long experience, that you can't force people to get insurance. People are clever and they will find all manner of ways to get around the requirements. And at the end of the day, laws requiring you to buy a private financial service do nothing about your back injury.
Statement of solution
Provide health care as a public good.
It's sad that none of our candidates is willing to boldly propose provision of health care as a public good. There are many public goods that we take for granted today, ranging from the important to the trivial. We take it for granted that we have free or low-cost uniform access to maps of all kinds, provided by the Geological Survey. We take it for granted that the National Weather Service will advise us on matters meteorological, and we take it for granted that we always have access to weather forecasts on the radio, anywhere in the nation, at no cost to the listener. We assume that we will have unfettered access to all kinds of data and statistics courtesy of the Census Bureau, the Bureau of Labor Statistics, the National Institutes of Health, the Securities and Exchange Commission, and numerous other agencies. We take for granted that which is probably the largest entitlement ever bestowed upon us: the Interstate Highway System.
And yet, despite these massively successful public entitlements, nobody is willing to propose health care as an entitlement. People are afraid to suggest such a thing for fear of being called a socialist or worse. I've never heard anyone ranting about the evils of socialized topographical maps. I have never heard anyone seriously declaim socialized weather forecasting. But I have heard, read, and seen people of all stripes decrying socialized medicine. They decry it so vociferously and with such passion that our leading thinkers are afraid to suggest it. Our top politicians won't go near the subject. And our candidates for president play it safe, cooking up schemes that sound like universal health care but are in fact means of directing money into insurance firms.
I think it's time to change the discussion on health care. How can the average working family meet their health care needs? I think they can do it by walking into a free clinic in the morning and walking out with a diagnosis and a treatment plan, at no cost whatsoever. How can people cut through the tangle of health insurance claims and denials? By eliminating health insurance as a legitimate line of business. How can we insure the 47 million uninsured Americans? We can't. But we can make a better system in which insurance is irrelevant.
We have the means to do this. We have the doctors and nurses and dentists. We have the facilities, and we have the universities, and we have the professional societies. We have the money. All we lack is the leadership.