The national political class doesn’t have much stomach for comprehensive health care reform (i.e., universal coverage, single-payer), so it has fallen to the states to try and expand coverage to a greater number of Americans.
The success of these efforts, however, is rather illusory. The number of uninsured Americans is growing despite plans like those in Vermont and Massachussetts, which should not be a surprise given that most of them rely to at least some degree on private insurers.
A column in today’s Boston Globe by Benjamin Day, executive director of Mass-Care: The Massachusetts Campaign for Single Payer Health Care, offers a pretty good explanation for the pitfalls that state plans face.
Massachussets, he writes, has three classes of plans — full-cost plans, partially subsidized plans and fully subsidized, free-coverage plans. It also fines state residents — $1,000 in 2008 — “who are deemed able to afford health insurance but fail to enroll in a public or a private plan.” The state had hoped that the program would extend coverage to hundreds of thousands and that the full-cost and partially subsidized plans would minimize the number of people taking advantage of the free plans.
That hasn’t happened. So the state is proposing a change.
The administration’s reforms would refuse eligibility for this safety net to everyone who is eligible for the state’s subsidized health plan, Commonwealth Care, along with anyone offered “affordable” insurance by their employer. The proposal would also, for the first time ever, impose cost sharing — deductibles and copayments — on many of the exclusively low-income patients who rely on the pool for medical care they can receive nowhere else.
This, Day says, would “cripple the state’s only program that guarantees that low-income, uninsured residents have a place to land when all else fails” in an effort to boost enrollment of other plans. He says the plan will punish the poor without accomplishing the goal of providing health care to all.
There is a long and unfortunate history to this line of thinking, which has led to the erosion and, at times, the vilification of our economic safety net institutions. From the Work Relief programs of the Great Depression through Welfare to Workfare, attempts to erode income security have been proposed as a way to corral the unemployed into the workforce. In the United States, the only developed nation without a national universal health plan, the health safety net is targeted as a means of corralling the uninsured into traditional insurance plans.
There is little evidence that eroding safety net programs actually helps improve participation in the labor market or the healthcare market. This does, however, succeed in punishing the poor, throwing low-income communities back on their own resources, and increasing the stigma upon safety net recipients.
The answer, then, is not to rely on state plans that are nothing more than Band-Aids and do what Michael Moore, U.S. Rep. Dennis Kucinich (a Demcoratic presidential candidate) and others advocate: Create a national system of universal coverage, administered by the government and paid for out of our taxes.
Will this be simple? No. But health care needs to be treated as a right and not as an economic benefit of employment. The current system is expensive, inefficient and detrimental to our economy — as General Motors.
It is time we joined the world’s other industrialized nations on this.
South Brunswick Post, The Cranbury Press
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Hank Kalet 