Public Agenda Issue Guide: Health Care - Consider The Choices

ISSUE GUIDES: Health Care

CONSIDER THE CHOICES

PERSPECTIVES IN BRIEF

Use Competition to Make the System More Efficient

Expand the Current System to Cover More People

Create a National Health Care System

The main problem with the healthcare system is that costs keepgoing up. All the other problems inthe health care system stem fromthis and won't be solved until wegive everyone real choices andthe ability to take responsibility forwhat they spend on care. Thatmeans reducing regulation andusing free market competition toallow insurers to offer a widerrange of plans. We should alsoembrace managed care, whichwatches expenses carefully andhas already slowed down theincrease in health care costs. Bymoving further in the direction ofmanaged care, and adoptingmedical savings accounts, whichencourage individuals to saveand shop around for health care,well be able to bring down costsand cover more people.

We dont need to rip up theexisting health care system andstart over. We already have thebest high-tech medical centers inthe world and insurance programsin place that cover 85 percent ofAmericans. We can just extendthose proven programs, publicand private, to cover morepeople. We can also give employersfinancial incentives to covermore of their employees. Thefederal government already haseffective health programs for theelderly (Medicare), the poor(Medicaid), low-income children(CHIP) and its own employees. Ifwe expand the eligibility for thoseplans, well be able to cover moreuninsured people with the leastdisruption to those who alreadyhave insurance. Gradually expandingthe current system is themost practical way to cover morepeople without breaking thebudget.

Decent health care ought to be abasic right, not something thatdepends on the job you hold. Ourpatchwork health care system ofprivate insurance and governmentprograms simply isnt working.Its time to try what Canadaand most European countriesalready have: a national, government-run health care system. Thesystem would work much likeMedicare, except that everyonewould be entitled to coverage,regardless of age, income or jobstatus. Like Medicare, youd stillpick your own doctor, but thegovernment would get the bill.Weve debated what to do abouthealth care for years, but nothingelse has solved the problem. This isthe only way to solve the problemof the uninsured, once and for all.

PERSPECTIVES IN DETAIL

Use Competition to Make the System More Efficient

Expand the Current System to Cover More People

Create a National Health Care System

What should be done?

Encourage more employers toprovide coverage through HMOsand other forms of managed careto ensure competition.

Encourage small businesses tojoin together in insurance pools tonegotiate for better rates.

Give patients more ways to payfor care, such as tax-free medicalsavings accounts that can beused for premiums, co-paymentsand deductibles.

Encourage the use of lower-costgeneric drugs and allow people tobuy approved drugs from Canadaand Europe. Charge patients moreif they insist on brand-name drugs.

Allow private insurers to createbasic policies that would coverthe most common problems andmake coverage affordable forsmall businesses and individuals.

Lower the Medicare eligibilityage to 55.

Extend the Childrens HealthInsurance Program cutoff age to25.

Increase Medicaid funding andraise the income cutoff to coverthe working poor.

Open up the federal employeeshealth insurance program to allowindividuals without insurance tobuy coverage at favorable rates.

Offer tax incentives for businessesto extend health coverageto part-time and low-wageworkers.

Create a Medicare-style singlepayer system, where the governmentprovides health insurancefor everyone.

Allow patients to get a standardlist of covered healthservices from any doctor orhospital in the program.

Raise taxes or repeal existingtax cuts to fund the program.

Tie the new health insurancesystem into existing governmentprograms to promote goodnutrition, mental health awarenessand exercise.

Arguments For This Approach

If the health care systembecomes more efficient, we canprovide more services for morepeople, without spending moremoney.

The constant rise in health carecosts hurts everybody it makesthose with insurance pay moreand it makes insurance tooexpensive for low-income people.

The only way to control costs isfor insurers, health care professionalsand patients to make decisionsabout what they really want andneed. That means empoweringpatients to set aside money taxfreefor medical care and allowingthem to seek out cheaper alternatives,like drugs from other countries.

HMOs and other forms ofmanaged care control costs byrelying on competition, ratherthan heavy-handed governmentprograms.

By expanding existing programsand employer-provided insurancewe can cover most of the uninsured.

This is the least disruptive way ofattacking the problem it wontrequire massive changes in howthe health care system operatesor how people get their insurance.

People will still be able to picktheir own doctors and health plansand get the same quality of care.

Health care should be a right,not a privilege for those luckyenough to have a good job, or tobe over a certain age. This approachis the only way to guaranteethat everyone gets medicalcare.

Countries with national healthcare systems often have goodhealth care at a lower costbecause the government canmake bulk purchases of drugs andcontrol costs.

This will actually reduce paperwork.Doctors and hospitals willonly have to deal with one set offorms and one governmentagency, rather than dozens ofprivate companies and governmentagencies, all with differentrules.

Any new taxes will be offset bythe savings earned when employersand workers no longer have topay insurance premiums.

Arguments Against This Approach

This approach will do little toexpand health care to the millionsof Americans who dont haveinsurance.

This will mean patients will haveto face a lot more red tape andmay even be turned down fortreatment an insurance companydecides is too expensive.

Under managed care, decisionsabout treatment are often madebased on whats the cheapesttreatment, not necessarily thebest one.

The real reason health carecosts are going up is because ofnew, expensive treatments andthat the population is gettingolder.

This will require people to make critical, complicated choices when they're sick and at their most vulnerable.

This will be an expensive expansionat a time when the federalgovernment already has a budgetdeficit, and we still will end up withsome people uninsured.

The Medicare program isalready at risk and will likely gobroke as it deals with aging babyboomers. Adding more people toMedicare will just cause theprogram to collapse more quickly.

This will do nothing to controlhealth care costs, which are risingat an outrageous rate.

Under this plan, a governmentbureaucracy tells you what healthcare you can have.

In Canada and other countriesits common to wait months forelective treatments or surgery.

This will require steep taxincreases. All the health carecosts now paid by private industrywould be taken on by the taxpayers.

The Canadian and Europeanhealth care systems are expensiveand those nations struggle tocover their costs without breakingthe budget.

Health costs will still be a burdento businesses, which will trade ahealth insurance plan they controlfor a health care tax they cant.