There are few words that incite greater passionate reactions on both sides of the political spectrum than "universal healthcare." I was initially reluctant to post anything on the matter because I was concerned about what kind of firestorm of comments I might unwittingly arouse. Through the course of a few conversations with different people and trying to gather some more information on the matter, I was surprised at my own level of misunderstanding, and I wonder if some of my misconceptions are shared by others.
I think my first "a-ha" moment was when I realized there is a difference between universal healthcare and universal healthcare coverage. The words "universal healthcare" have a very negative connotation in my mind. My initial reaction is to imagine a very socialized, almost Soviet style central planning and state ownership and management of healthcare services. I think heavy administrative bureaucracy, escalating costs and decreasing care would likely result from that type of system. Perhaps in its initial form this is what some people were proposing, but I don't think it has many supporters today. What I am learning is that more emphasis is being placed on universal healthcare coverage.
Universal healthcare coverage still relies on private industry. It seeks to make sure that everyone has access to health insurance to pay for medical treatment provided by private industry; it does not expect these services to be provided by the government. Again, that was a vitally important distinction for me to begin to understand.
There is disagreement on how access to this health insurance is to be gained. Some people want to require all employers to offer healthcare coverage to their employees. I would be concerned that the administrative and financial burden would be very detrimental to small businesses and the overall economy. (I know with my dad's experience, his business would probably have immediately gone under if he had that additional cost.) At this point, I think having state administered group plans that are available to everyone appears to be a better alternative. There are currently plans in place in each state called SCHIPS which expand medical coverage to those who make enough to not be eligbile for medicaid but can not afford private insurance.
I think there could be a lot of progress made in assisting the millions of Americans who do not have healthcare insurance and coverage (and therefore little access to appropriate levels of care) through a combination of strong SCHIP programs coupled with Health Savings Accounts. I have not seen anyone linking the two together yet, but I think it is an important step to take. I think deductibles, doctor co-pays and first dollar payments are an important check on the system that prevent over-use and abuse. The financial burden of these personal payments can be eased by the use of HSA's.
The issue of universal healtcare coverage and poverty are obviously interlinked. This is also why I would support an increase in the minimum wage. I am not sure where that stands right now in Congress. I think it would be far better to raise the minimum wage and provide additional income for lower income individuals and families to purchase healthcare through a state program than to require each small business to create and administer its own plan. It is also possible for states to subsidize these programs and further make health insurance affordable.
There still needs to be major reform within the healthcare industry itself, with greater emphasis paid on preventative and holistic care and greater use of information technology to reduce both burdensome administrative paperwork and the risk of malpractice. But that is probably another story for another time.
Some articles and resources I found interesting and helpful:
How to Heal Health Care
The Reformer and the Gadfly Agree on Health Care
http://clinton.senate.gov/issues/health/
http://johnedwards.com/about/issues/health-care/
http://www.newt.org/backpage.asp?art=3485
http://www.newt.org/backpage.asp?art=1897
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