Going to School on Health Reform

Is it possible we can use education as a role model for how health care should work in this country? The big debate at present is whether or not to offer a public insurance plan (e.g. Medicare for everyone) as part of the health reform plan. Critics are worried that public plans will restrict access to care, lower the overall standard of care, create extraordinary public debt, and drive private insurers out of business as they can’t compete with a not-for-profit model. Those in favor are claiming that unless there is some public option to drive competition costs will never decrease, and without public funding of health care millions will continue to go uninsured. The annoying part is that both sides are mostly correct.

It strikes me that we’ve sort of solved this problem once before, in the field of education. Everyone is provided a basic K-12 education at public expense, regardless of income, need, or any other criteria. If you are motivated and can afford it, you can send your kids to private schools. That’s your choice, but it doesn’t get you out of paying your share of taxes that fund public education. At the college level, most (all?) states provide some subsidized university programs that require students to fund part of the coverage as well. And there are lots of private schools out there that for a hefty sum will educate you at your own expense. While it’s hard to make generalities, it is pretty well accepted that in aggregate the private schools are providing a better education than the public schools. But for the vast majority, public schools are just fine.

Applying this model to health care, every citizen would be entitled to basic health care. This may not cover all the latest treatments, elective procedures, or extraordinary care, but it would be a solid basic coverage that would provide a desperately needed security blanket to the uninsured and those fearing unemployment because of its attendant loss of coverage. Then private insurance could be used to subsidize that basic coverage. Employers might still offer “umbrella coverage” as an employment benefit. States could offer subsidized umbrella plans to their citizens if they chose to do so.

In this way, those of us getting excellent care today would continue to get that care through a pair of complementary plans. Those without care today would get basic coverage they desperately need. Costs for basic care should be well contained, and capitalism is still alive and well. The only down side I see to this is that insurance companies’ business models will change dramatically, but I’m hard pressed to work up a lot of sympathy for them. It may be hard to get this past their lobbyists though.

And yes, this will raise your taxes, but it should also lower your expenses and/or raise your salary. Also, if the costs go down as anticipated, it may be a net gain for us in the end. It seems worth a shot. We certainly need to try something significant. Simply tweaking the existing system is clearly not going to get us where we need to go.

2 thoughts on “Going to School on Health Reform

  1. OK Tim. I'll play devil's advocate here.
    If we have government funded healthcare, will they make cheeseburgers illegal because they're unhealthy? Will the government health czar decide we're all vegetarians from now on? The insurance companies have already manged to out-lobby the tobacco industry, disguising their profit motive as care for the patients. Will it now be some beaurocrat trying to justify his job that decides what's next? Oh man, I hope they don't outlaw Rum & Cokes!

  2. Government already makes things illegal that it deems unhealthy: Saccharine, red dye number 2, cocaine, and even Rum (for awhile at least).While it's hard to tell based on the reluctance to legalize pot, I think the government is smarter than to try and outlaw something as popular as cheeseburgers, alcohol, or even tobacco. They would create an instant black market, and turn countless former law-abiding citizens into "criminals".

    The only additional motive to make a move like this now would be to control government spending. and I think governments have repeatedly proven that this is not a goal they are too serious about.

    Bureaucracy in any form is prone to abuse, whether those bureaucrats are public or corporate employees. As you point out the existing structure is already abusive.

    The government is already in the insurance business. Social Security, Medicare, Medicaid, FDIC, FEMA, and many other organizations already provide financial protection for U.S. citizens. There's no reason to suspect that health insurance will be managed worse than any of these.

    One thing in our favor is that health care that covers all citizens will be hard for the government to be abusive about as it will effect everybody. It will be much like Social Security in that regard. You virtually can't lower SS benefits because it effects all of us now or in the future. Health care will be even harder to mess with as it will effect all of us now.

    So I think there's fairly little to fear here. It's hard to imagine it could get more screwed up than it is now. But just to be sure I'll throw some ground round in the freezer and stock up on the Captain Morgan for you.

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