The Commonwealth Fund's Surprisingly Relevant Universal Coverage Proposal

Last week, Karen Davis and Cathy Schoen of the liberal Commonwealth Fund released a surprisingly centrist proposal for universal health coverage. This marks a big change. For decades, the liberal academic community has insisted on “single payer” government-run national health insurance. The left usually advocated expanding the Medicare entitlement for seniors to all Americans, or creating systems patterned on the Canadian model and run by state governments.

But there is certainly no political consensus for government-run national health insurance. Setting aside the debate about whether single payer systems would actually be better for Americans’ health (on balance, they wouldn’t), simple political reality dictates that advocates of universal health coverage should unite behind more realistic proposals that feature public/private cooperation.

That is why the Commonwealth Fund’s proposal is so important. Breaking with liberal tradition, Davis and Schoen embrace the central idea that people should get health coverage by choosing among multiple private health plans. Their proposal would create a “Congressional Health Plan” that would provide most Americans with the same choices of coverage offered to federal employees and members of Congress.

The proposal also embraces the centrist idea of an individual mandate to purchase coverage, which was revived recently by Senator John Breaux (D-LA). Requiring all Americans to purchase coverage would help bring premiums down, because insured people would no longer have to indirectly pay the costs of the uninsured who show up in emergency rooms and receive uncompensated care.

To make coverage affordable, the Davis-Schoen proposal includes tax credits to help families with low incomes, and subsidies for transitional health coverage to help the unemployed.

Of course, the Davis-Schoen proposal is not fully centrist. It also contains a misguided “pay-or-play” requirement for business, and its proposals to expand the Medicaid program for the poor and SCHIP (the State Children’s Health Insurance Program) for lower-income kids go far beyond what is necessary to bolster the public “safety net” for those under poverty.

Nevertheless, most of the main themes of the proposal are acceptable. Davis and Schoen weave ideas from think tanks ranging from the center-left Progressive Policy Institute (PPI) to the conservative Heritage Foundation into their plan.

Other Democrats are working on similar proposals. This week, Senator Jeff Bingaman (D-NM) is set to release a proposal drafted with the assistance of the American College of Physicians/American Society of Internal Medicine that also features tax credits, Congressional-style purchasing pools, and targeted expansions of public programs.

However, not all progressives are on the bandwagon. Rep. Dick Gephardt’s (D-MO) proposal to cover the uninsured, also announced last week, relies on another old liberal standby: a hugely expensive requirement that employers provide coverage. Like single payer proposals, however, an employer mandate to provide health insurance is breathtakingly expensive, paternalistic rather than empowering, and above all, a political non-starter.

With the number of uninsured now 41 million and on the rise, liberals should support ambitious, realistic proposals to expand health coverage. Those who cling to fading dreams of single payer systems or rigid employer mandates are inadvertently helping postpone needed action.

The Commonwealth Fund’s Davis and Schoen are sending a signal for the left to “get real.” Their proposal is hardly perfect, but it is breath of fresh air in an otherwise stale and largely unproductive debate.

Links:
Karen Davis and Cathy Schoen Creating Consensus on Coverage Choices (Health Affairs, April 23, 2003)
Jeff Lemieux A Relevant Universal Coverage Proposal (Health Affairs, April 23, 2003)
Senator John Breaux A Radically Centrist Approach To A New Health System (January 23, 2003)
Heritage Foundation Time for Bipartisan Action to Help Families Without Health Insurance by Stuart Butler (March 20, 2002)
Progressive Policy Institute A Progressive Path Toward Universal Health Coverage (December 2000)

Posted by Jeff Lemieux at April 26, 2003 02:20 PM