[Peter Suderman]
Elizabeth Edwards has some questions about John McCain's health-care policy. I certainly think she frames her question in a way that ensures maximum political potency. But I have some quibbles and questions.
No plan, even with a mandate, really provides for truly universal coverage; Massachusetts hasn't managed to sign up everyone with its supposedly universal plan, and even in France, there's a very small percentage who are left uncovered. But granted, an Edwards-Clinton style mandate would guarantee coverage to more people.
She also asks if competition will really lower costs considering that we have competition today and costs are rising. Well, yes; costs are rising today, but that's in part because people weren't happy with efforts made by insurers to reduce costs. Costs briefly held steady in the mid 90s as a result of managed care, but there was considerable frustration with the limitations managed care put on patients. No one likes rising costs, but no one likes being forced into narrow care schemes either. Giving insurers more flexibility to design affordable plans, rather than piling on the state-level requirements, probably would push costs down, and allow those seeking coverage more options in what they want to pay for and what they don't. You can portray this as a "race to the bottom," as she does, but it also allows for more efficient insurance that's not weighed down by expensive, and often unnecessary provisions.
And while no insurer would be required to cover either Mrs. Edwards or McCain under the McCain scheme, that doesn't necessarily mean that either would be prohibited access to insurance either. Government and employer plans of the sort that both rely on for coverage would still exist. It's not as if McCain would take away anyone's care; he simply wouldn't push additional requirements on insurance companies.
It's easy, of course, to get bogged down in details: The question, in the end, is whether health care is a universal right. When someone falls ill, is it the responsibility of the collective—all the citizens of the nation -- to bear the costs of treatment? Or is it the responsibility of the individual, through whatever financial means, personal connections, or other agreements he or she has made, to arrange for care? And if there is an obligation, how far does it extend? Basic as these questions may be, it's tough to answer other, more specific questions until you have answers on these. A lot of people tend to answer purely pragmatically -- I don't care! I just want to provide better health care to more people -- or at least me -- on a short or medium term basis. That's understandable. But I also think it's that lack of certainty on the underlying principle which has caused a lot of the confusion and systemic problems in the way we currently provide coverage and care.
Competition between health plans? There is no such thing, not if you mean compared to auto insurance or any other widget manufacturer.
You are not the customer, you're the customer once removed: your employer is the customer. They are the one who decides what health care is available to you. You merely pick the employer. You don't like living in a factory town? Too bad, you get the factory doctor.
If there is to be universal coverage, why is the car insurance model not the most prudent route?
Competition between health plans? There is no such thing, not if you mean compared to auto insurance or any other widget manufacturer.
You are not the customer, you're the customer once removed: your employer is the customer. They are the one who decides what health care is available to you. You merely pick the employer. You don't like living in a factory town? Too bad, you get the factory doctor.
If there is to be universal coverage, why is the car insurance model not the most prudent route?
"When someone falls ill, is it the responsibility of the collective—all the citizens of the nation -- to bear the costs of treatment? Or is it the responsibility of the individual, through whatever financial means, personal connections, or other agreements he or she has made, to arrange for care?"
Neither/both, in my opinion. I think that health is pretty closely related to life and pursuit of happiness. So in that sense, I think it's a right. I say, "health" generally, not medical care specifically. Health isn't just about getting to a hospital if you get sick or injured. It's also about preventing illness and encouraging wellness. This includes things like sufficient facilities for exercise, good information about the food we eat, adequate dental and mental care, among other things.
I think there are corresponding responsibilities to each right. It's the responsibility of the individual to care for their own health - for both acute and chronic conditions - to the extent that they are able. I think it's the responsibility of the nation collectively to help people who are willing, but not able (can't afford), to take care of their health. It's also the responsibility of the nation collectively to prevent people from endangering the health of others. Quarantining people with infectious diseases is the most obvious example of this, but I think the principle could be applied elsewhere.
Whatever plan we come up with should address the moral hazard involved with 3rd party payer systems. People, generally speaking, should pay for their own health care and health insurance. Government can help the poor and chronic cases. Everyone else pays as they go is the most cost effective.
Isn't there another (additional, that is) reason for rising health-care costs?
That is, new, expensive treatments and equipment?
If we didn't want standards of care to continuously improve, it'd be pretty easy to cap costs - but people, oddly, do want better care over time.
"Costs briefly held steady in the mid 90s as a result of managed care, "
The enrollments in HMOs, which contributed to controlling costs, are nowhere near enough to account for the bulk of the phenomenon. The plot of health care costs as percentage of GDP makes an audible thunk with the election of Bill Clinton as it hits a ceiling and flattens. Costs declined more because fear of nationalization than people switching to HMOs. Another alternate possibility, though less likely in my opinion, is that HMOs attained a market penetration that caused PPOs to adopt more competitive behavior. Either way, participation in HMOs doesn't come close to explaining it by itself.
Ms Edwards understanding of a "race to the bottom" is precisely, empirically wrong. Mandates are a race to the bottom -- the goal becomes the least expensive route to compliance. In a competitive environment, the goal is to design a plan that consumers want to buy.
This is Econ 101 stuff and it's sad to see these sort of warmed-over socialist ideas. For other fundamental needs, where the market is reasonably free -- food, clothing, personal transport -- we get increasing quality at decreasing costs.
A single-payer system, where providers are compensated regardless of consumer satisfaction, is the true race to the bottom.
Health care can and should become almost trivially cheap over time. Technological advance combined with competition is the model. To the extent that we box in providers and consumers with mandates, we end up with disempowered consumers and a static market.
Matt S:
Except it hasn't become cheap. In fact it grows ever more expensive and everyone admits it will get a lot more expensive over time. Since you hate socialism so much, what do you think of the bail out of Bear Stearns? Do you dislike that bit of socialism? Would you have called "B-52" Ben and Hank Paulson socialists three months ago? Yet they just proved they are socialists(in so much as it benefits their rich friends.
In a competitive environment, the goal is to design a plan that consumers want to buy.
You mean healthy consumers. No insurer wants to insure the sick or the likely to become sick. Pity that they're the ones who actually need the health care.
Tel:
Being ill (or dead) is not a violation of your natural rights. The key is "pursuit". You have a right to pursue life, health and happiness unencumbered by coercion. Granting the ends themselves as fundamental rights necessarily grants you the right to coerce others to provide these ends (after all, what if you are unable to obtain them yourself?). The right to pursue good health and the right to good health are mutually exclusive.
And what if you are willing to make the choices that lead to better health but are unwilling to make the choices that lead to enough wealth to pay for better health? For instance, should society provide for the health of those who voluntarily drop out of school when healthy, thereby denying themselves job opportunities that might enable them to pay for their own health care?
Joe K's Conscience, yes, I agree that the bailout of Bear Stearns is probably a bad thing (read: huge moral hazard), but that's off-topic so I'll resist the urge. To the point...
Health care in this country is already around 40% paid by gov't. (Someone correct me on this figure.) It's not a very free market. Add the mandates and you realize that an inexpensive plan is essentially illegal.
Also, the US market sustains most of the world's R&D, so in effect we are subsidizing every other gov't health system. It's amazing that our health care costs are not higher, frankly.
Some good examples of what can happen in a functioning market are the cheap clinics popping up in CVS and Wal-Mart, and their selling of prescription drugs for $4 as a loss leader. These are good, innovative things.
I would love to buy health insurance from Wal-Mart, and I suspect they could offer something very competitive for low-income people -- were it not for mandates and risk of litigation.
"Being ill (or dead) is not a violation of your natural rights. The key is "pursuit". You have a right to pursue life, health and happiness unencumbered by coercion. Granting the ends themselves as fundamental rights necessarily grants you the right to coerce others to provide these ends (after all, what if you are unable to obtain them yourself?). The right to pursue good health and the right to good health are mutually exclusive.
And what if you are willing to make the choices that lead to better health but are unwilling to make the choices that lead to enough wealth to pay for better health? For instance, should society provide for the health of those who voluntarily drop out of school when healthy, thereby denying themselves job opportunities that might enable them to pay for their own health care?" - Alex S.
I'm afraid I disagree on almost all points, in the first paragraph. Being dead is a violation of my natural rights, if someone has killed me. Being sick is a violation of my rights, if someone else has done something (by comission or omission) that causes me to become sick or to remain sick when health is possible. The right is to life, not to pursue life; I think the right is to health, not to pursue health. Yes, I have and ought to have the right to coerce someone who is attempting to deprive me of life. If I'm unable to prevent that, the law ought to hunt the killer down afterwards. A doctor who can assist me if I'm injured, can and should be required to help me (i.e. he can't refuse to treat me unless there are very good reasons).
For the second paragraph; yes, society should pay for those people. Practically speaking, there will always be people who fail. But people can still vote and speak freely even if they didn't finish high school. We don't penalize people for not paying a 1/300 millionth share of the national defense budget, or the budget to run the court system or the voting booths. We allow them to benefit from all of those, even if they only own the clothes on their back and don't pay a cent in taxes. Why should health be different than those other rights?
As you say, "The question, in the end, is whether health care is a universal right. When someone falls ill, is it the responsibility of the collective—all the citizens of the nation -- to bear the costs of treatment? Or is it the responsibility of the individual, through whatever financial means, personal connections, or other agreements he or she has made, to arrange for care? And if there is an obligation, how far does it extend?"
My anwswer to this is to look at what society actually requires. We DO have a social safety net it is called the emergency room. Now, ignoring the current abuses, it seems that society's standard is that in the case of an emergency/catastrophic condition money should be no object.
In order to address affordability first you need to address where the money is going.
Through standardization in billing you could streamline administrative costs.
By opening up more medical schools, (in addition to h1-b visas), you can, in time, create a surplus of doctors and bring their costs down.
The toughest but by far most effective way to address health care costs is to get the individuals that make up our society to do two things: Eat right and exerecise.
The fact is this would reduce the number heart attacks, strokes, cancer, diabetes, and a host of other health problems dramatically reducing the demand for health care and its costs.
In the end, the ugly truth is the indivdual is ultimately resposible for his or her own health.
Currently, we're an increasingly obese nation of couch potatoes that somehow believe healhcare cost and health are unrelated.
"Being ill (or dead) is not a violation of your natural rights. The key is "pursuit". You have a right to pursue life, health and happiness unencumbered by coercion."
This is a fundamental misquote. The phrase is "Life, Liberty, and the Pursuit of Happiness," not the pursuit of all three. Life, not the pursuit of life, is an inalienable right.
We must come to understand that when we stop thinking only of "I" and started caring about "We", we will be significantly better off as a country -- more educated, more healthy and able to work, more likely to weather individual storms of life. More productive, for you free-market junkies.
Personal responsibility is not mutually exclusive from a "we" mentality. It merely factors in responsibility to the community instead of solely basing 'responsibility' on narrow self-serving interest.
Every child has the right to arrive at the age of 18 having had every needed medical access, and to not be limited in opportunity because we have failed to provide them medical care. After that, they need to take responsibility to be a contributing, self-sustaining member of society.
If a medical event disrupts that status and they can't weather it on their own, "We" as a community will be better off if we help them and get them back on their feet and contributing.
Agreed and that’s why it’s so disingenuous for Clinton and Obama to say that under their plans everyone who is happy with their existing health care (which seems to be most people) can keep it. In fact what both have proposed through their national exchange is to impose a new rounds of mandates (at the federal rather than State level) which every private plan will be required to include which means that (a) your premiums will continue to accelerate because of the new mandates and (b) things that are covered now by your plan but not mandated could be dropped to make room for the things that are required.
Add to that the “pay or play” mandate that would require employers to provide health insurance to their employees by law and your take-home pay will take an even bigger hit as instead of paying their employees higher wages and salaries, employers will be forced to devote more of it to higher health insurance costs.
Do you really trust the Federal Government to manage socialized medicine? This is the same organization that has destroyed public education, given us an income tax system that noone understands, and cannot come up with a plan to control immigration into this country.
Tel,
So you would agree that simply being sick is not, in and of itself, a violation of rights, correct? You point out that the illness would be someone else's fault "by commission or omission". Since it would be absurd to argue that if everyone performed their duties faultlessly, no one would ever get sick or die, there will be some people who have only themselves or their luck to blame for their condition. In order to get better health care without paying for it themselves, these people would have to coerce others (or lobby the government to do so), even though no one ever coerced them. Do they have the fundamental right to engage in such coercion if it is necessary to secure good health? What if you replace "good health" in this situation with "happiness", another circumstance you would grant to all as a fundamental right? May we use coercion to secure greater happiness?
Being coerced into supplying healthcare to others who won't/can't supply it for themselves is a violation of my rights to pursue happiness. It is also a violation of my right to liberty. And to the extent it takes a part of my labor time, it is also a violation of my right to life.
This is the problem with positive rights- there are no clear demarcations, and they always violate negative rights.
Yes, I would say that they do have the right to demand treatment. Particularly if it's only through bad luck; even poor people don't ask to be born with a genetic disorder, or to get an infectious disease.
But they should be able to demand help with their health, even if they have themselves to blame. Using the voting analogy, someone who decides not to vote still has the right to call on his congressman to vote a particular way on an issue. That guy might be obnoxious to the rest of us, but nobody denies him the right to act that way. The non-voter can even decided to vote against the congressman next time around, if he doesn't like how it goes. Or take another analogy; a person decides to live in a known high-crime area, and gets mugged as he's walking home alone at 3am. He should still expect and demand the police to help him, even if he was being stupid when he was robbed. He would be silly to do this, but he's perfectly free to keep walking home alone at 3am. The cops still have to investigate, no matter how many times he gets robbed.
If we have a "right" to health care, why don't we have a right to food or shelter?
Which would kill you quicker: the inability to go to a doctor, or being deprived of sustenance or housing?
What kind of heartless society are we to leave such important human needs to machinations of the heartless market?
Seriously, it all comes down to this: rights are free. It costs nothing for government to allow to you to speak freely, worship whatever you like or possess a gun.
Giving somebody the right to a house, a meal or a doctor sounds nice.
But those things will have to be provided by force.
For the carpenter, the farmer or the doctor: that's servitude.
And there is nothing free about that.
In the last analysis, society has decided you do have a right to food and shelter. If you're destitute, public authorities will steer you to a homeless shelter and will find some means of providing you with food. It's been like that for hundreds of year in western Europe. Free schooling and public libraries were added in the nineteenth century. More recently, most of the developed world has decided that medical care will also be provided if needed. All these things are paid for by taxes. I agree with this way of doing things, and I understand that social benefits of this sort are paid for out of my taxes. Evidently, John Rogers objects. He has a right to his views, but I think they're extremist even for the people who read this blog.
Have I missed something or has the government stepped in and prevented insurers from designing affordable plans?
Nope, turns out you can sell a policy that only covers Herpes if you choose, at any deductible you desire.
I'm not saying we should do away with private health insurance, though an argument can be made to that effect. But seriously, if you frame the question on obviously false assertions why should I keep reading?
Davebo,
http://www.law.uh.edu/healthlaw/perspectives/Mental/990331Mandated.html
In at least 17 states you can't sell health insurance that doesn't offer mental health care coverage parity.
Did you really not know that many states mandate that certain things be covered?
The only argument we ever had against government coercion is that above all, individuals have a right to be free. Now that we have established the supremacy of society's interests over individual freedom from coercion, what will you say when any of your personal choices in the future are challenged by the government in the name of the greater good? I hope you're not counting on the government voluntarily stopping its growth, or 'society' voluntarily staying out of the lives of its individual members. The history you note suggests the opposite trend.
The government caused the entire problem with health care in America by over socializing (with unfunded mandates) medicine to the extent it is not completive. The government allows a monopolistic pharmaceutical environment, and the FDA a federal agency failing American citizens and needs be eliminated or completely re-organized; it’s corrupt, and is causing a major impact on the cost of healthcare in America, and we want to exacerbate the problem? http://www.InteliOrg.com/
John Rogers is spot on.
Imagine yourself shipwrecked with a few other people (including a carpenter, fisherman, and doctor).
Natural rights - speech, worship, association, defense of one's person, life, liberty, pursuit of happiness - all still exist without the existence of a formal government and don't require coercion of your fellow passengers.
Access to healthcare requires either cooperation or coercion of the doctor. It is not a "right".
And if it is a "right", shouldn't the proponents of this view also demand that we condemn other nations who don't provide it to their citizens for human rights violations?
Yes, you have missed something. You've missed quite a bit actually. Insurance plans are very heavily regulated. It's illegal to offer health insurance that fails to cover certain procedures (a list that is largely determined by the political influence of the individuals performing those procedures).
If I understand John Rogers and his supporters, compulsory schooling is wrong because it deprives kids of their liberty and their parents of their tax dollars. This is an outrage. All schooling should be privatized, including community colleges and state universities. Public libraries are also an infringement on our liberty.
So are municipal water systems and publically supported hospitals.
In fact, every service supported by tax dollars should be privatized, with the possible exception of the police and the fire department.
Is this really what libertarians stand for?
Davebo,
You're kind of a dumbass aren't you?
http://www.cnn.com/2008/HEALTH/conditions/04/01/autism.insurance/index.html
Re: If we have a "right" to health care, why don't we have a right to food or shelter?
We do. Ever hear of Food stamps? Section 8? Homeless shelters?
Re: But those things will have to be provided by force.
Everything the government does it does by force. Everything. Period. And no one is suggesting that doctors, grocery stores or home builders should not be paid for their labor. That's a strawman.
But if you don't likr living under compulsion, why not drop out of society entirely? I think that old-fashioned hermiting should be a viable option for people like you. But for sure you are hypocritical if you want to enjoy the benefits of social living without sharing in the obligations.
Re: Being coerced into supplying healthcare to others who won't/can't supply it for themselves is a violation of my rights to pursue happiness.
Assuming you are a doctor or othe healthcare provider, please see the above. No one is proposing that you not be paid for your services.
Now as to Megan's larger question, I am astonished that it even has to be asked-- after 20 centuries of Christian ethics and at least 100,000 years during which even the simplest human societies (the prehistoric Neanderthals for example) considered it obligatory to care for their sick and injured. This is almost as breathtaking as someone asking "Should we have public restrooms?" or "Before we debate vouchers, shouldn't first debate if we should educate the young at all?"
JonF,
Being coerced into paying for someone else's healtcare is also a violation of my negative rights. You don't get to dodge the issue by misreading.
Also, Christian ethics is dealing with voluntary charity, not state compulsion.
Weren't the taxpayers of Yancey's home town coerced into paying for his public school education? What is he doing to right this hideous wrong? The world wonders.
Rights do pre-exist government coercion - that's why they're "natural" rights. Health also pre-exists government coercion. You can be perfectly healthy living alone in the wilderness, if you don't injure yourself or catch a disease. Health is the base state; something has to happen to you for you to lose that health.
But I would also argue that rights aren't free. If you have a government, it does cost the government something to guarantee that rights are maintained. The government takes some action - or threatens to take action - against people who violate those rights. The defense and promotion of each right requires time, money, and effort. This should not be surprising to anybody.
Now, I have not said that there is a right to a specific kind of health care, just a general right to health. The details of health care are the details of how the government goes about securing that right to health. All of those details are certainly debatable, just like how the government goes about securing the rights of free speech and freedom of religion. And just like the other practices of the government, rights will have to be balanced against each other. If you had a religion that demanded human sacrifice, to take an extreme example, the victim's right to life would be judged as more important than the believers' right to free exercise.
The question Suderman thinks is the basic question here -- is it society's responsibility to care for the ill when they cannot care for themselves? -- would be an interesting and important one, had it not been settled decades ago. Is there anyone in America who believes that a fellow American should be left to die in the street if he suffers a heart attack and cannot pay for treatment? If there is such a person, I invite him to stand up and be voted down by the other 300 million Americans, just as he would have been voted down by a crushing majority at any time since the passage of Medicare and Medicaid over 40 years ago.
Every American gets access to care, by right, and regardless of wealth or connections. It remains to argue over the most efficient method of providing this access in a way that maximizes Americans' health.
Natural rights - speech, worship, association, defense of one's person, life, liberty, pursuit of happiness - all still exist without the existence of a formal government and don't require coercion of your fellow passengers. - m.jed
Not if your fellow passengers are Chinese, and have none of your assumptions about the "right" to free speech, worship, association, etc.
Rights are culturally dependent. In fact, in most shipwrecks, they are not honored; one is highly likely to have one's "right" not to be eaten by other passengers disregarded. One may cry to the high heavens that one's rights are being disregarded, as one's fellows are gnawing on the roasted ham of one's severed leg, but in this case one's "right" to the defense of one's person has become about as relevant as one's right to health care.
Stan,
My parents paid for my education, and paid for that of others as well since they were relatively more wealthy than most within the community I grew up in, which was quite poor.
However, nice try at deflection.
Next.
brooksfoe,
As usual, you completely miss the point.
There has to be a limit to what qualifies as a right. How much healthcare is someone entitled to by right? The answer is none. Your right to healthcare ends at your ability to secure it for yourself in voluntary cooperation with others. That you have managed to steal these means from others by threat of force doesn't make it a right, just that you are amongst the majority of thieves.
One may have an ethical obligation to help a fellow human being in need, but that still doesn't mean they have a right to that help.
How much healthcare is someone entitled to by right? The answer is none. - Yancey
This may be your position on the question, Yancey, but you and whatever half-dozen people agree with you on this have lost every vote on the issue in the United States since 1964, at least, and you will continue to lose every vote on the issue until the end of time. Emergency rooms are obligated by law to treat anyone, regardless of the ability to pay. Anyone with AIDS is entitled to ARV treatment, regardless of the ability to pay. And so on. The American people do not agree with you. That is that.
You have a reified conception of what constitutes a right. I am sure you are familiar with many examples of positive rights which are by now deeply incorporated into American assumptions -- children's right to a basic education, for example -- but which were not at all part of the way that "rights" would have been understood by John Adams, by John Locke or by Plato. You should be familiar with these examples because they have no doubt been presented to you over and over and over in arguments such as the one we are now engaged in. Yet you persist in repeating the exact same simplistic errors you always make. You would be a more interesting writer if you gave some evidence of having already encountered and grappled with the obvious rebuttals to your arguments, rather than pretending to be ignorant of them.
So, brooksfoe, is the argument then that in theory, we ought to have X right because in practice we do have X right?
Aren't you putting the cart before the horse?
brooksfoe, you are confusing entitlements with rights. Our society has said that everyone is entitled to emergency health care, but that's not equivalent to saying that everyone has a right to emergency health care. The government could alter than entitlement (in either direction) without recourse (beyond the basic democratic process) from the citizenry. The lack of recourse is what distinguishes an entitlement from a right. To make an absurd example, if every doctor and nurse quit tomorrow, no one would be receiving any health care but neither would anyone's rights be violated.
That said, the term "right" is often used in everyday conversation in the sense that you're using it but I don't think that makes it a correct usage.
Re: Also, Christian ethics is dealing with voluntary charity, not state compulsion.
Christian ethics is neither voluntary nor purely personal. That's been true since very ancient times. If this were not the case Christian activists would not be advocating laws against abortion, among other things.
And way back in the day when the Church had the job of dispensing welfare (including healthcare) the Church could tax people, either directly by requiring tithes (and no, you were allowed to drop out of the Church), or indirectly, by claiming a share of the governmment's tax revenues.
To make an absurd example, if every doctor and nurse quit tomorrow, no one would be receiving any health care but neither would anyone's rights be violated. - SG
You have an overly reified and ahistorical understanding of the concept of rights.
You have an overly reified and ahistorical understanding of the concept of rights. - brooksfoe
And you have a Marxist concept of rights. I'll stick with Adam Smith.
My view is hardly ahistorical, it goes back at least to Thomas Hobbes and is realized in the English and US Bill of Rights. I'm aware that there are those who claim that positive rights exist, but I've never heard a compelling justification for it. I'm willing to listen, but your flat assertion is not compelling.
I agree that we as a society can say that we are willing to provide health care to all of our citizens irrespective of their ability to pay, and in doing so create a "right" to health care. But that "right" is conditional on the democratic process. Any right that can legally be altered or rescinded without recourse hardly seems worthy to be called a right.
It does seem to be all the rage to define new rights, but I think it's much clearer to define these sort of socially constructed rights as entitlements (or even better as privileges). As a society we can choose to grant a privilege equally to all, but that privilege derives from the social contract (i.e., it's not a natural right) and as such can be renegotiated at any time. A renegotiation can change the nature of the entitlement (welfare reform, social security reform, health care reform, etc.) and no one's rights will be violated.
Your use of the term "right" is not unique, nor wholly unjustified, but I think it's worth distinguishing what the government can't do with what the government chooses to do. Using the same term for both erases that distinction and discourse is made the poorer for it.
Health care most definitely is a recognized and protected human right in modern-day societies the world over! We Americans are no different in that the majority of us want to join the rest of the civilized industrialized world and enact a national health program.
Anyone remember a woman named Eleanor Roosevelt and a little project she led? It's called the International Declaration of Human Rights, not the Int'l Declaration Social Contract Privileges!!
Why do so many Americans insist on making things more complicated than they need be? The corporate medical-industrial complex perpetuates that thinking to obstruct support for common-sense reforms, so let's not add to it!
Article 25 of the Universal Declaration establishes the right to medical care. See http://www.un.org/Overview/rights.html . Thankfully, we now have many cost-effective services for disease prevention and health promotion that make good sense for both economic and humanitarian reasons, so we appropriately strive to provide health care not only medical treatment of disease.
To gauge where the American public is on this issue just examine the findings of poll after national poll of both the public and groups of health professionals and it's clear that the approach that fits our values and our culture is a course of step-by-step reforms that put the reform process SQUARELY on track toward the end point of improved Medicare-for-all type program. Yes, it will be a part of the social contract and it will also be a program that recognizes the right to health care.
The corporate opposition to the goal of a national health program that's no longer controlled by insurance co's, drug co's and large hospital chains is expert at using misleading scare tactics. The streamlined financing that's used with Medicare-for-all (single payer) will SAVE BILLIONS. It will not require new funds. In fact, that's why a time of recession may be ideal for advancing this most common-sense reform.
RE the mandate issue: Any reform plan that maintains the dominant role of the private market-driven insurance industry and then attempts to use an individual mandate to reach universal coverage is a horribly flawed and misguided approach concocted by ivory tower economists (read Jonathan Gruber at MIT and John Houlihan at Urban Institute) and is not workable in reality. The truth about the individual mandate plan in MA and how it's falling apart in more ways than you can imagine in cannot be hidden from the public for too much longer.
I'm sure the Edwards' have the best intentions for supporting the economists mantra for an individual mandate but I'll guarantee you that it would not pass in the US Congress and it will not work to achieve its stated goals. Might look good on paper but does not work.
Contact me if you'd like me to email you official state Insurance Connector documents that demonstrate how badly the MA Mandate plan is going on its steady trajectory toward failure. Sadly, the failure is not a benign one; already there are enormous cost overruns while the state faces a ~$1Bil state budget deficit, we have far-from-universal coverage (300,000 remain totally uninsured despite the threat of mandate penalties b/c they can't afford to buy insurance, hundreds of thousands more are very under-insured, and already tens of thousands are being "disenrolled" from the new Insurance Connector plans), new "schedules" were approved for significant cost-shifting to the low income on subsidized plans in the interest of keeping this thing going a bit longer. Contact me at ann*at*defendhealth*dot*org
So, what to do? Support candidates at all levels who pledge to help get us on track toward the humane and workable solution of Medicare-for-all. We'll be cheating ourselves, and our children and grandchildren, if we aim for anything less than maximum cost-savings with free choice of doctor and hospital and that means aiming for American Medicare.