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.