The Way Forward on Health Care by Harold Ford, Jr. and Al From
The next president will have no choice but to fix our health care system. On the Bush administration’s watch, the number of Americans without insurance has jumped from 38 million to 47 million. Insurance premiums have risen at four times the rate of inflation, and deductibles have grown 87 percent — even as benefits have shrunk. For businesses, the cost of providing health insurance for workers has become a devastating competitive disadvantage in the global economy. Health care costs are rising twice as fast as workers' wages.
To hear President Bush and the GOP nominees for president tell it, every Democratic health care plan is a giant step toward government-controlled health care. Rudy Giuliani is quick to label any plan as "socialized medicine." He’s not telling the truth. In reality, not one of the three leading Democratic candidates for president — Hillary Clinton, Barack Obama or John Edwards — has endorsed a Canadian-style, government-run, single-payer approach. Rather, all three support plans that build on the current American system of private insurance, plans are grounded in the principle of shared responsibility — a principle under which individuals and employers each take on a manageable share of costs, with the government filling in the gaps where needed. Each would offer consumers a choice. Everyone who has insurance would be able to keep their current plan if that is their preference. But the proposals all call for the creation of purchasing pools or insurance exchanges that allow individuals to choose the plan they desire after comparing prices and benefits — a vast improvement, even for those currently covered. All three plans require that employers help to pay for coverage. For big companies that already provide insurance, the transition would be smooth and largely painless. Clinton's proposal also includes a smart provision that provides small businesses with a tax credit for making contributions to their employees’ coverage. If the businesses choose not to contribute, the credit is then transferred to the workers.
Most importantly, the Clinton and Edwards proposals both include an individual mandate — meaning they would require everyone to buy health insurance. An individual mandate is critical for both moral and practical reasons. To put it simply, health coverage is not merely a private benefit — it is also a public good. Health insurance protects Americans against bankruptcy and gives patients access to life-saving treatments. At the same time, patients without coverage shift costs onto everyone else when they use expensive care and can’t pay for it, as when the uninsured rely on emergency rooms for drastic care that might have been more cheaply and safely managed with preventive medicine. All three plans are a radical departure from both the government-run, single-payer plans that many Democrats have supported in the past, and the every-man-for-himself attitude that seems to underpin Republican thinking.
