Expanding Group Coverage is the First Step
Health policy debates are often characterized by false choices. Should we focus on covering children or adults? Should we focus on expanding coverage, or reducing cost? Should we pursue reform at the state, or at the federal level? Should we attempt fully universal coverage, or in strategic steps?
Most of these questions are not “either/or,” but “yes, both.” As Yogi Berra said, “when you come to a fork in the road, take it.” I am a firm believer that we need to have a vision of quality, affordable health coverage for all America, but we need to fight the battles of the moment.
That said, there are dividing lines about the direction reform should go. Most people will simply look upon any health reform and ask: will care be available, affordable, and adequate to my needs, when I need it?
For those who look at the health system as a whole, I think health consumers are most at risk when they are left on their own. Right now, it is individual self-pay consumers who pay more than anyone else in the world for health care — whether prescription drugs, hospital care or health insurance. Public programs, employers and other large purchasers, in contrast, are able to negotiate for better rates.
So I am opposed to John Graham’s desire for an even more deregulated system, one where people are at the mercy of market forces. I am skeptical about Lucian Wulsin’s preference for the Wyden-Bennett bill, which seems to encourage people into an individual market, rather than group coverage. While this would be a regulated market, I don’t think that is enough to balance the lack of market power that an individual has — or doesn’t have. In order to level the playing field, government should not just be regulator, but a negotiator and/or a competitor. That’s the hope of the “public health insurance option” that has been discussed in health policy circles.
I thus agree with Claudia Chaufan’s analysis of the benefits of pooling risk, but think that is an argument for a range of reforms that expand group coverage. A universal, single-payer system is one solution I support, but other solutions are worthy of attention and advocacy.
Right now, we have a President committed to health reform, an outline of which he campaigned on vigorously — he spent more than $100 million in television ads just in October promoting his health plan. His plan would expand group coverage, provide much-needed assistance to millions of uninsured and underinsured, and create the framework for additional reform efforts — addressing access, cost, and quality — in the future.
We need to take the fork in the road, and I am optimistic that it will take us forward.
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