This is a terrific piece by Ezra (No Relation But Sometimes Called The Good) Klein about what other countries, including the “country” of our own VA system, do about health care.
A caveat from the Not-So-Good Klein, though: services as basic as health care systems, even our own non-system, are pretty much cast in stone–dynamite or a drastically altered economic dynamic are the only ways to change them. Which is why it’s going to be very hard to change ours, and impossible to completely eliminate role that insurance companies play.
But there is a hopeful paradigm shift afoot: Corporate America doesn’t want to pay for health care anymore, and may be willing to lobby for a universal system that includes them out…As a result, I think there’s real hope for Senator Ron Wyden’s universal plan–and, last time I checked, so does Ezra–which would replace the employer-based system with one where health care is funded through progressive tax credits (and subsidies for the poor). In other words, the wealthier you are, the more you would pay. As I’ve written before, Wyden would impose two mandates: everyone would have to buy into local versions of the federal employees’ system, which offers a variety of private plans, and the insurance companies would have to cover everyone at the same rates, regardless of pre-existing conditions.
No Presidential candidate has endorsed a Wydenesque plan yet–John Edwards’ system is the exact opposite: an employer-based, pay-or-play scheme…but I suspect each of the Democrats, and perhaps a few Republicans, are going to have to disgorge a universal plan before the presidential election is over. I wonder if any of them will pursue the obvious leverage: corporate America will support universal health insurance if it no longer has to pay for it.
Update: A reader who inaccurately calls himself Joe Klein’s Conscience raises an important question:
So does that mean workers get an automatic 15% pay increase? You aren’t gonna let corporations pocket every penny they save from not having to pay for health care, are you?
Answer: Yes it does. Wyden’s plan would require employers to “cash out” their health care benefits to employees so the workers can use the money to pay premiums to the government under the new system.
And finally, those readers congratulating me for “finally” supporting universal health care are about 15 years late: I’ve supported a universal plan with an individual mandate and refundable tax credits for the working poor ever since I opposed the Hillary Clinton “employer mandate” plan in 1993. Wyden’s is the best iteration of this idea that I’ve seen.