2003-11-18 -- NY Times op-ed favors a universal single-payer VOUCHER system

Today's NY Times ran a 1/5 page Op-Ed piece, favoring a universal,
single-payer VOUCHER system, a gift to insurance companies. When the
Times says, "Vouchers are our only solution to our health crisis," we
need to remember there is no "our" health crisis. There is the health
crisis of workers and their families, and there is the health crisis
of corporate America. Here is a SF Gray Panther leaflet distributed
at a phony Robert Wood Johnson "Insure the Uninsured" conference this
spring.

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Universal healthcare, not corporate profits!
Why is business so interested in the uninsured NOW?

For years, big business hasn't given a damn about people not having
medical insurance. Since the early 1980s, they've laid tens of
millions of us off, cut millions of current workers and retirees off
medical benefits, and made their coverage so expensive that millions
cannot afford it even when it is offered. So you've got to suspect
something is fishy when they start being so concerned about whether we
have medical insurance.

We already know about our healthcare crisis: 41 million of us
uninsured, a safety-net in tatters, coverage with inadequate benefits
and drug plans, high co-pays, a hospital system rife with dangerous
mistakes, and the worst health indicators in the industrialized word.

Corporations see an entirely different healthcare crisis; falling HMO
and health insurance profits, rising and uncontrollable health costs,
millions of ageing baby boomers with expensive diseases, a sputtering
economy, huge federal and state budget deficits, and an expensive
open-ended war ahead. From their viewpoint, something must be done.

These Robert Wood Johnson "Covering the Uninsured" conferences are
being held to generate public support for the corporations' healthcare
plans:

Part of the corporate plan is to simply bail out HMOs and health
insurance companies by covering the uninsured using private health
insurance companies and government tax money. California Blue Shield
wants to be a big player, and has been speaking to business groups
around the state with flashy newspaper publicity in San Francisco and
Los Angeles. Blue Shield is hiring some 300 more workers to handle
anticipated new business. Blue Shield has insisted on having major
speakers at the "Covering the Uninsured" conferences, because, as
conference organizers them-selves say, Blue Shield has put in big
money.

"Covering the Uninsured" using government tax money can be very
profitable for private insurance companies, but only if they can offer
extremely cheap, stripped-down benefit packages. Remember, private
insurance companies dropped hundreds of thousands of Medicare and
Medicaid patients because the companies could not profit enough with
standard benefits and government payments, and we know government
payments will be even lower with deficits and war. So one of the
insurance companies' top priorities is to devise a new "basic" level
of benefits that the insurance industry and the government can agree
upon as a standard of care. These companies are also working to limit
medical malpractice claims in order to protect their profits against
the suits from injuries and deaths they know will come from their
lower level of care.

But these corporate plans are not just to help HMOs and health
insurance companies alone. They are to benefit the entire corporate
economy. A large percentage of all companies' workers are uninsured,
some 80% of uninsured have jobs or are dependents of those with jobs.
It would save companies money and possible labor unrest to insure
those workers at taxpayer expense through private insurance. In
addition, companies are determined to reduce health costs of their
covered employees, as the recent strikes at General Electric show.
Once a stripped-down "basic" benefit package was standardized for the
uninsured, companies would be sure to switch their covered employees
onto these "basic" benefits. These plans are what we do NOT need!

We demand single-payer government-based healthcare financing!
No insurance companies, no crazy-quilt payment structure!
We demand a single benefit package for all, for all health needs!
Quality care for all, no discrimination against the poor!

San Francisco Gray Panthers, 415-552-8800,
graypanther-sf@sbcglobal.net

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November 18, 2003
The Universal Cure
By EZEKIEL J. EMANUEL and VICTOR R. FUCHS

"Vouchers are our only solution to our health crisis."

he public has good reason to be worried about health coverage. After
five years of relative stability, insurance premiums,
prescription-drug prices and other costs have soared. This year,
premiums went up nearly 14 percent, with those paid by employees
increasing nearly 50 percent since 2000. The number of Americans
without health insurance increased more than 5 percent just in the
last year. And strikes by workers in Los Angeles and elsewhere showed
that health coverage is the flashpoint of labor discord.

As a solution, many policymakers are advocating small reforms like a
Medicare prescription drug benefit and expansion of the Children's
Health Insurance Program. Unfortunately, more services for some groups
may increase costs and force reductions in coverage for others.

What we need is a fair proposal that is simple, efficient and
appealing to disparate constituencies. For more than a decade, as
members of the medical and economics communities, we have advocated
such an alternative: universal health care vouchers.

In a morally responsible country, everyone should have health
insurance. Each family or individual would be given a voucher to
purchase a policy that covered basic services, including doctor
visits, hospitalization, pharmacy benefits, some mental health and
dental care, and catastrophic coverage. People who want more services,
like wider choices of specialists, could pay a premium over the basic
voucher.

This would continue to be a decentralized system with existing health
plans contracting with providers, but their insurance would no longer
be employment-based. That Americans receive insurance from their
employer is a relic of World War II wage controls. It has one
advantage - pooling people to reduce premiums - but many
disadvantages, including locking people into jobs so they can continue
to receive health coverage and allowing employers to choose insurance
providers. It has also become an albatross for businesses. Without
costly insurance worries, companies could compete for workers by
offering higher wages and better working conditions.

A voucher system would also enable the government to end Medicaid and
phase out Medicare. Having multiple health care systems squanders
resources. All Medicaid recipients would receive vouchers. Each year,
those who normally age into Medicare would be enrolled in the voucher
plan instead. Current beneficiaries who preferred traditional coverage
would not be forced to switch, although after total Medicare
enrollment dropped sufficiently, the program would be amalgamated into
the voucher system.

One consistent concern about vouchers is that health plans would have
financial incentives to avoid the sick. But requiring each insurance
company to offer a basic package with catastrophic coverage would
insure that individuals with greater needs would not be excluded. More
important, the voucher system would pay insurers part of their cost as
a lump sum and part as a reimbursement fee for actual services
rendered, reducing the incentive for insurers to avoid sick patients.

A national health policy board would administer the system, including
certifying health plans and insurance companies, managing the vouchers
and payments and collecting and disseminating data on the quality of
care.

The United States now spends about $1.4 trillion on health care. The
government already pays about 45 percent of that. In 2003, the average
health insurance premium for a family of four is about $9,000. Using
that figure and population numbers, a universal health care voucher
system would cost about $840 billion, excluding Medicare. That would
leave substantial sums for individuals to pay for out-of-pocket
expenses and services not in the basic package.

More important, using an earmarked tax to pay for the vouchers would
limit cost increases. The level of the tax would determine the value
of the voucher. If the public began demanding an increase in the
voucher value, it would be directly linked to higher taxes, moderating
these demands and health care inflation.

Obviously, many details need to be elaborated. Nevertheless, vouchers
hold the promise of securing wide support. Democrats have long favored
the notion of universality, while Republicans instinctively favor
voucher plans and have longed for the demise of Medicare and Medicaid.
Businesses want to stop providing health insurance, and Americans want
guaranteed health coverage with choice.

With the inexorable explosion in health care costs and the increase in
the number of uninsured, a crisis seems at hand. The universal health
care voucher can secure both widespread support and finally establish
a fair, functional health care system in the United States.


Ezekiel J. Emanuel, oncologist and bioethicist, is author of "No
Margin, Nor Mission." Victor R. Fuchs, professor emeritus of economics
at Stanford, is author of "Who Shall Live?"