The Future of Universal Health Care, as of Now

Every day that goes by without a vote in the House or Senate on universal health care makes it less likely that major reform will occur, because (1) opponents have more time to stir up public anxieties about it; (2) Democrats up for reelection next year come ever closer to the gravitational pull of the midterms, and grow increasingly worried about voting for a bill that could be a political liability in a year when unemployment may well reach double digits and the electorate is restless and unhappy; and (3), as a result of the first two, proponents increasingly have to rely for support and cover on industries like Big Pharma and insurance, as well as physician specialists and equipment suppliers, none of whom have any interest in fundamental reform but all of whom see possibilities for making more money out of whatever bill emerges.

In other words, next fall we get something called “universal health insurance” that still leaves millions of Americans uninsured and doesn’t substantially slow the meteoric rise of health-care costs. That would be a tragedy.

What should be done now to avoid this?

First, the House must enact a bill before August recess even if the Senate is unable to — and the House bill should include the four key elements that have already emerged from House committees: (1) a public plan option, (2) a mandate on all but the smallest employers to provide their employees with health insurance or else pay a tax or fee (so-called “pay or play”), (3) a requirement that every individual and family buy health insurance, coupled with subsidies for families up to 300 or 400 times the poverty level in order to make sure it’s affordable to them; and (4) a small surtax on the top 1 percent of earners or families to help pay for this subsidy (“tax the wealthy so all Americans can stay healthy.”)

Second, the President must tell Congress in no uncertain terms that all four elements are necessary. I believe he should also signal his openness to capping the amount of tax-free health care that individuals or families may receive from employers — so long as the cap does not erode the tax-free benefits of individuals or families in the bottom 80 percent of the earnings distribution. This is the only funding mechanism that may be able to garner sixty votes in the Senate, and the only one that the Congressional Budget Office has so far said would temper the rise in long-term healthcare costs.

Third, the President should make clear to Big Pharma, private insurers, and other interest groups now supporting the effort that the final bill must contain mechanisms for forcing them to come up with the cost savings each has promised. Otherwise, those savings cannot be assumed — and they won’t be “scored” by the Congressional Budget Office — thereby making it difficult for waivering members of Congress to vote for the bill.

Fourth, the President should commit to visiting, during the recess, all states of waivering Senate Democrats and even a few moderate Republicans (read Maine), in order to take the case for universal health care directly to their constituents. He or the Vice President and cabinet members should do the same in the congressional districts of all Blue Dog Democrats and other waivering House Democrats.

Finally, you, dear reader, must contact your senators and representatives and explain why you want genuine reform — incorporating the four elements listed above. Mobilize and energize others to do the same, especially residents of Blue Dog states, including Montana where Senate Finance Chief Max Baucus resides. And if you’re able and willing I’d urge you to descend on Washington the moment Congress returns from recess. There is nothing quite as persuasive to a member of Congress as real live constituent demanding real reform.


Originally published at Robert Reich’s Blog and reproduced here with the author’s permission.

3 Responses to "The Future of Universal Health Care, as of Now"

  1. devils advocate   July 28, 2009 at 8:16 am

    Dr. Reicha time of economic anxiety and huge deficits means we need to focus on cost-cutting our un-health system which is so costly – but because of the enormous influence peddlers/lobbying on our Congress … obvious to voters…and the Administration -counting on preventative care to save hundreds of billions, pulling numbers out of the air by guestimates, and not facing TPTB to pull profits out of the system…not trusting the American people to face the facts and make the hard choices…basically this Administration has been unwilling to lead a popular revolutionwhich viable health care reform requires

  2. Guest   July 29, 2009 at 7:16 am

    That the Democrats would attempt an overhaul of one-sixth of the economy when Americans are extremely fearful of their future, the nations’debt level and ever-increasing taxation, demonstrates that they are arrogant,immture and too concerned with their legacy. President Obama is making himself look like a fool as he continues to assure the public that proposed legislation will allow them to keep the insurance plans they have, when the bills prohibit this. Government bureaucrats will micro manage very complex medical decisions. Stop bashing specialists. Primary care doctors limit the number of Medicare patients they will see, whereas the most vilified of all specialists – cardiologists- have practices with 50 to 60% Medicare patients. These people save lives every day, but are vilified for using technology that keeps many more heart pateints alive and productive than ever before. Your approach, like most economists, belies your ignorance about what it takes to take care of people.When it comes to medicine, the devil is in the details, best left to well-trained doctors, not power-hungry bureaucrats.

    • Mike   July 31, 2009 at 10:07 am

      Obviously, the writer of this response has a terrific medical plan which will fully cover the cost of his next by-pass. Unfortunately, many Americans will be personally and tragically bankrupted by medical costs this year and some will forgo the treatments they simply cannot afford. Having a hard working single parent and a child end up in a shelter because that child gets cancer is simply criminal. The cost of the medical care in the US is outrageous – costs that will continue to rise if we maintain the status quo. The fool is not one who at least tries to fix what is universally perceived as broken, but the one who resists change for resistance sake. Sure, leaving medical decisions to well trained (and honest) doctors is fine, but leaving medical decisions to doctors who have a vested interests unnecessary procedures and tests and insurance companies who have a vested interest minimizing their cash outflows by denying coverage of expensive illnesses is not the way. The system needs to be fixed.