THE DEBATE BETWEEN Senators Hillary Clinton and Barack Obama on health care probably looks like a small nuance in two proposals that are remarkably similar. But the issue at the center of their dispute reflects a lot about our present health-care system and how to achieve genuine reform.
What’s generating the heat is a concept called “individual mandate” — using the power of government to force uninsured individuals to buy health insurance.
Senator Clinton claims that the only way to achieve “universal” coverage is to require everyone to have insurance. Senator Obama says people don’t have insurance not because they don’t want it, but because they can’t afford it. Both are skipping the main problem.
It’s true that no plan can be called “universal” unless everybody is in. It’s also true that skyrocketing costs have priced millions of Americans out of access to care. A Kaiser Family Foundation 2007 survey found that average family premiums are now $12,106 — not including the additional charges for deductibles and co-payments for everything from doctor’s appointments to prescription drugs to emergency care.
Costs are the central story today, cited by most Americans as their major worry about their health coverage, and are why health care is the leading domestic issue in the presidential race.
The trouble for most of these families is not the lack of insurance, though; it’s the insurance they already have. Consumer Reports in August reported that four in 10 Americans are “underinsured.” Half postponed needed medical care because of cost. One quarter had outstanding medical debt. Only 37 percent said they were prepared to handle unexpected major medical bills.
It’s hard to imagine how forcing more people to buy insurance solves these problems, especially when none of the top three Democratic candidates has advocated any cost constraints on the insurers, drug companies or other industry giants.
The individual-mandate fad started with two Republican governors — Mitt Romney, who made it a centerpiece of a Massachusetts law, and Arnold Schwarzenegger, who is trying to make it the law in California.
While some pundits laud Massachusetts, there’s an underside. Despite the Dec. 31, 2007, deadline, after which everyone who was not insured now faces tax penalties, only about 6 percent of the uninsured who did not qualify for public assistance had bought insurance as of last month. Why? Because of the high cost. In California, the governor and the Democrat-controlled legislature now both support individual mandates, but are not close to finding a way to make it affordable.
Their ideological argument is that individuals must be made responsible for their own health-care costs, rather than society as a whole. The underlying message is you’re on your own. But, if Obama is right about the fatal flaw in individual mandate, he’s still off base in his failure to take on the primary source of our health-care morass.
The major Democratic contenders are at least talking about large-scale reform — in stark contrast to the Republican candidates, who seem to think more tax breaks for the wealthy are the solution. But everyone is ignoring the gorilla in the room.
Having insurance is not the same thing as receiving care. Nothing proposed by the top-tier candidates of either party would end the thousands of horror stories of insurance companies denying needed care, access to specialists or diagnostic tests, even when recommended by a doctor.
Nothing in any of their plans, other than a vague reliance on the magic of the same market that created the present crisis, would hamper insurers from charging what they want — and pushing more families into bankruptcy from medical debt — or forcing them to self-ration care because of the cost.
As premiums have ballooned by 87 percent in the past decade, insurance-industry profits have climbed from $20.8 billion in 2002 to $57.5 billion in 2006. During that same period, health-care interests spent $2.2 billion on federal lobbying, more than did any other sector, and as of last month, had flooded the presidential candidates with over $11 million in campaign contributions to keep the present system intact.
There’s one alternative that would guarantee coverage for everyone, protect choice of doctor, promote cost savings by slashing administrative waste, and get the insurance companies out of the way. It’s called single-payer reform, as in an expanded and improved Medicare for all. The candidates should demonstrate the courage to talk about this one real reform.