A draft health care proposal to be submitted for approval this fall calls for universal health coverage for all U.S. inhabitants, “regardless of legal status,” which would be funded by means of a new “payroll tax.”
The proposal, “developed over a two-year period by the Task Force on Universal Coverage” and sponsored by the American Academy of Family Physicians, “concluded that the only way to achieve health care coverage for all people in the U.S., regardless of legal status, would be to approach it as a ‘social good’ and acknowledge that participation must be mandatory.”
The plan, which will be submitted for approval to the Academy’s Congress of Delegates in the fall of 2001, likens the mandatory approach to government-mandated K-12 education. Also, the task force found that “there are a set of basic services that most people are expected to utilize in their lifetime, and that there should be no financial barrier to these.”
The group also said it “felt that a catastrophic injury or condition should not have catastrophic financial implications for individuals and their families,” and in order to prevent this has proposed that all people in the U.S. have catastrophic protection with limited co-payments.
Panel members, however, did say individuals “should have responsibility for deciding their own level of risk tolerance for those services that would fall in between ‘basic’ and ‘catastrophic’ and therefore would leave to individuals, employers and the insurance market how and whether to insure against these.”
Financing of the plan, the panel said, would be accomplished through the levy of a new “payroll tax to be paid by all employers and employees. These funds would be distributed to states to administer the basic/catastrophic services.
“The services to be covered would be determined through a public/private explicit process to be developed,” a summary of the plan said. “All individuals would have coverage for these services.”
The plan would, however, exclude those covered under “Medicare, CHAMPUS, the VA health system and the Indian Health Service. Medicaid beneficiaries would receive their basic services the same as other people in the system, but would retain the additional benefits that they currently enjoy from the Medicaid program,” the summary said.
According to figures published by the task force, if the plan was in force in 2001, employers would have to spend an “average of $360 more per worker on health care, with a range of $141 to $810,” or about $41.4 billion more annually. Average per-capita household spending on health care would increase by $579.
However, AAFP said, state and local spending on health care would decrease by about $7 billion a year, though overall, health care spending would rise about $46.8 billion annually, “with part of the increase offset by savings in administrative costs.” The “administrative savings” would amount to a fraction of that — just $7.8 billion, according to AAFP’s estimates.
Richard Roberts, M.D., J.D., president of AAFP and a professor of family medicine at the University of Wisconsin, told WorldNetDaily that some businesses would pay more for health care under the proposals, but others would not.
And, regarding increased costs to individuals, Roberts said the proposal “provides them with security.
“Many people are in job lock — they may want to leave a job but they don’t feel they can because of loss of health insurance,” he said. “Others who are out there are sort of doing it on the fly and taking the risks, but the cost [of medical care] is already being borne” by businesses and those who have insurance.
Roberts also said that under the proposal some physicians may lose a degree of earning power, but it’s possible many would actually earn more because of guaranteed payments.
The AAFP president also said his organization wanted to incorporate “a Federal Reserve-type private sector oversight board instead of leaving this in the hands of government bureaucrats” to ensure that payments were made properly and so that states and their residents could decide on the best insurance solutions.
“We like to refer to our program as assurance, not insurance, because under our basic and catastrophic care proposals, people will be assured of medical coverage,” Roberts said, noting that “these are only proposals — we haven’t settled on an actual plan yet.”
Critics of similar universal health care plans have said that ultimately, the political goal of those groups and individuals advocating it is to permit the federal government to run all of health care, which would be tantamount to handing one-seventh of the U.S. economy over to bureaucrats and new health agencies.
Also, they say government-paid plans are already wasteful and inefficient, costing taxpayers tens of billions of dollars a year — a figure that would inevitably increase if Uncle Sam made health care cost decisions for all Americans.
In the July/August 2000 issue of Medical Sentinel, Lawrence R. Huntoon, M.D., PhD., president of the American Association of Physicians and Surgeons and a practicing neurologist in New York state, compared universal health care to “socialized medicine.”
“Indeed, ‘universal coverage,’ nationalized health care, or socialized medicine, regardless of what you choose to call it, is not the same as medical care,” he wrote in a paper titled, “Universal Health Coverage — Call it Socialized Medicine.”
“All of the citizens of Canada, for instance, have ‘universal coverage.’ What they often don’t have, however, is the medical care that they need when they need it,” Huntoon said.
Other groups who decry universal health care, like the libertarian-leaning Cato Institute, say Americans would be better served if federal and state governments exercised less — not more — control over the nation’s health care system.
For example, in a 1998 paper, “The Cato Handbook for [the 106th] Congress,” the group argued that health care costs could be held down and more people covered under better plans if more medical savings accounts were permitted, if Congress passed a universal tax credit for health care costs, avoided more regulations and restrictions on managed care programs — particularly mandated insurance benefits — and enacted “complete Medicare reform.”
In Cato’s 1997 paper on universal health care, [Editor’s note: This document is in .pdf format; you must have Adobe Acrobat? to read it] researchers said that in the period between 1994 — the year a Democratic Congress and White House failed to pass universal health care — and 1997, former President Clinton managed to convince Congress to approve, by Clinton’s figures, about 60 percent of his original plan.
“In some cases,” Cato said, those proposals that were approved went even further “than the original proposals.”
“Slowly but steadily, the … government is assuming control over the American health care system,” researchers concluded.
“We need health care reform, but it needs to be based upon the principles of individual freedom and individual responsibility,” Huntoon wrote. “And, there are many options out there. Most people could purchase a high deductible indemnity insurance policy at a lower price than they would pay for monthly managed care premiums — a much higher quality of health care at a lower price.”
Acknowledging that there are “serious problems” with the nation’s health care system, Cato said anti-universal health care advocates say supporters of their view have been unable to “articulate a vision of free market reform,” thus allowing Congress the political cover to pass these measures.
Even today, nearly 41 million people are without health insurance coverage, and after a period of relatively minor growth in health care costs in the mid-1990s, costs are now beginning to rise again, making the push against universal coverage and care even more difficult.
Cato argues that the nation “does not have free market health care,” it has “privately-owned health care.” Thus, the health care market does not operate the way markets should operate, researchers said.
The think tank report said two components were needed for “successful markets.” The first, “on the provider side,” envisions “a wide variety of providers in competition with one another on the basis of price and quality.” The second, “on the consumer side,” sees “consumers attempting to receive the maximum quality and the lowest price, attempting to ‘get the best deal for their dollar.'”
“Unfortunately, the American health care system exhibits neither of those characteristics,” Cato said. “Providers have become increasingly cartelized, using government regulatory requirements to limit competition and mandated insurance benefits to guarantee a supply of customers,” via Health Maintenance Organizations and similar groups.
“On the consumer side, because our third-party-payer system insulates customers from the cost of their health care decisions, there is a strong incentive to ignore the cost of health care and overuse health care goods and services,” leading to price increases that come regularly as the population grows and becomes older.
Under the AAFP plan, employer spending for health care would increase “from 3.9 percent to 52.2 percent depending on firm size and type of industry.” But overall, Cato said that fully 48 percent of Americans with employer-provided health insurance are already dissatisfied with it because most employers only offered one plan that was HMO-oriented, thereby limiting choice for physicians and covered treatments.
The AAFP’s Roberts said his group’s proposal would not only provide basic coverage but would also allow persons to make their own choice to upgrade coverage under different, separate plans.
In the meantime, Congress has responded to the dissatisfaction by moving to regulate the HMOs and force them to provide minimum coverage and giving beneficiaries the right to sue HMOs if care is improperly or wrongly denied.
“However,” Cato argued, “increased regulation is the wrong way to deal with the problems of managed care.”
AAFP’s Roberts countered that his group’s proposal was not geared towards more government regulation, but instead he emphasized the civilian-private oversight board’s role in formulating policy, though Roberts said it was unclear how members to that board would be selected.
“We think there are some basic issues that Americans need to talk and think about and come to agreement on before we can move forward,” Roberts said. “Over the years, the health care debate quickly devolves into two extreme groups that throw bricks at each other — you’ve got the single payer, ‘Let the government do it’ group, and then you’ve got the market folks, ‘Let people go out and buy individual medical savings accounts’ group, and nothing much happens.
“You end up with more under- or uninsured people than ever,” Roberts said. “What are we going to do — as is beginning to happen — when the economic bubble we’ve all been enjoying begins to leak or burst and even more deserve employer-based health insurance?”
“We don’t have all the answers or all the details,” Roberts said. “What we really want to do is engage the American people in a conversation” about health care. “Our proposals are structured to that end.”
The AAFP said it was accepting public comments via e-mail and letter on its proposal until Feb. 28.
Despite the noble goals of providing some level of medical coverage to all Americans, many remain skeptical of the approach.
“Lenin once said that ‘medicine is the keystone in the arch of socialism,'” Huntoon wrote, “and I believe those who are promoting ‘universal coverage’ via government-run and government-controlled medicine know this. What they hope is that the public won’t find out the truth.
“There is nothing compassionate about socialism,” Huntoon said.