Universal Health Care How!

Obamacare, anyone?


Originally published in New Ground 109, November — December, 2006.

by Bob Roman

In New Ground 103, “Everybody In! Nobody Out!”, I predicted the obvious: that as the Adequate Health Care Task Force (mandated by the Health Care Justice Act of 2004, see New Ground 99, “The Health Care Justice Act Unfurls”) finished its work on recommending legislation to reform health care in Illinois, the Campaign for Better Health Care (CBHC) decisions on what to support would leave it “in trouble with some part of its constituency”. The moment is nigh. If not too many people are seriously pissed off at CBHC (I hope), the coalition it cobbled together for the Health Care Justice Act is fracturing nonetheless.

The Task Force had hoped to finish its work prior to the November election; however, its approach to the task, trying for a consensus among the stakeholders, has delayed its report until the start of the next General Assembly session in January. The recommendation (not surprisingly, see New Ground 103.2) is likely to resemble the plan passed early this year and presently being implemented by Massachusetts. While the CBHC’s 2005 meeting was studiously uncommitted, by May of this year CBHC had submitted a report to the Task Force that essentially asked the Task Force to examine various features of the Massachusetts approach. On the other hand, at the 2006 CBHC meeting this past October, Jim Duffett, CBHC’s Executive Director, made it clear that the CBHC would not automatically support whatever the Task Force produced.

The Massachusetts approach is a good example of the current fad in legislation: public policy as an item to be marketed. In this case, the “hook” is individual responsibility combined with community responsibility to facilitate the fulfillment of that responsibility for those who are poor. This is a powerful argument when expressed properly.

For health care policy, this means that individuals would be “mandated” to obtain health insurance, something like the way drivers are required to have automobile insurance. Typically this would be done as it is today: through employment. Employers would be “mandated” to provide insurance or, if they do not, to pay the State additional taxes. Individual policies would be subsidized for lower income levels, and Medicaid would be available for the truly less well off. The State would also set standards for insurance policies. Unlike automobile insurance, failure to buy health insurance would not be a criminal matter. In Massachusetts there are tax consequences. It’s pretty obvious that in such an approach the details are vitally important.

Those with some familiarity with health care policy will note that in preserving private insurance, the Massachusetts approach preserves the administrative overhead (and profits) that consumes an unfortunate portion of each of today’s health care dollar. Depending upon how the employer “mandate” is implemented, there will be an incentive for employers to dump employees into individual policies and for low-wage employers, Medicaid. Unless you assume that “demand for health care at zero price may be close to infinite” (There are economists that delusional. The quote is from “Implementing Mandates” by C. Eugene Steuerle of the Urban Institute, 1994.), a “single payer” approach is guaranteed to be far less expensive.

Many Massachusetts health care activists were not at all happy with being saddled with a health care plan that is kinder to insurance companies than it is to the health care recipient. In Illinois, an “Illinois Single Payer Health Care Coalition” is being formed to promote what will be a minority report from the Task Force for a “single payer” solution. There is also no guarantee that the insurance industry will be happy with what the Task Force comes up with, even though the Massachusetts plan was largely developed by Blue Cross Blue Shield.

Because enacting legislation on both the state and federal levels in the United States requires some degree of consensus, this split in the coalition probably does not improve prospects for health care reform in Illinois. But Massachusetts is going into its plan with a very large pot of money to cover the initial costs while Illinois has persistently failed to deal responsibly with its finances, including consistently failing to fulfill its constitutionally mandated responsibilities to fund education. Add to that a smaller Democratic majority in the General Assembly and plurality in the electorate as compared to Massachusetts and it becomes unclear that anything the Task Force might propose has much of a chance. It may be that this whole effort will become, at best, another exercise in public education.

There is such an unmet need for health care in Illinois that this ongoing disaster will be used to browbeat dissidents to the Task Force consensus proposal. How could they endanger passage of a reform that would make such a difference in the lives of so many? “Impractical” and “utopian” will be among the epithets deployed.

But an inadequate plan is not necessarily any different than no plan; Massachusetts is an example of this, too. This is not that state’s first experience with a universal health care plan. In 1988, Michael Dukakis got the state legislature to pass a public / private universal plan. Because of a failure of financing and political leadership, it was never implemented and was mostly repealed in 1996. Yet another failure of liberalism, in concept and politics. De ja vu all over again?