Universal Coverage: not-so socialized medicine?

While Democrats are certainly wary of having "Hillarycare" hung around their necks again, it seems that the debate over the form of a universal-style healthcare system has moved from inter-party to intra-party.

Republican Governors Mitt Romney and Arnold Schwarzenegger have unveiled new programs that propose to provide health care for every citizen of their state through a mix of mandates and subsidies. They are not the single-payer systems that conservatives are loath to see created, but they may represent its early stirrings.

Not surprisingly the two Governors–both from states with a distinctly moderate-to-left leanings–have come under fire from conservatives who see it as an attack on the "free market" system that insures us all; minus the roughly 47 million who go without.

On National Public Radio's Diane Rehm Show Tuesday morning, Thomas P. Miller, a fellow at the conservative American Enterprise Institute, called Schwarzenegger's proposal a "mandate on individuals, a mandate on businesses…a tax."

The Plans

The two programs–Schwarzenegger's plan is modeled after Romney's–share a number of attributes, as well as flaws, which opponents are quick to point out, including the basic mechanism that requires all state residents to carry health insurance. The state will then subsidize those who can not pay their way. To pay for the program the state will impose fees on businesses that do not provide insurance to their employees, and on hospitals' and doctors' gross revenue.

In a way, these programs front-load the costs that all taxpayers cover now. Instead of the uninsured landing in ER's and and clinics when they are seriously ill and the taxpayers picking up the bill, the programs suggest an alternative, to provide an incentive or opportunity for preventive care.

The programs are intriguing, but not without problems. The policies would be high-deductible ($1,000) plans, the sometimes-called "disaster" policies. The co-pays and high deductibles often keep many low-income individuals from taking full advantage of preventive care and thus still end up with serious, and expensive, illnesses.

Perhaps the most interesting aspect is the requirement that insurers cover any and all comers. Efforts like these are designed to reduce cherry-picking so that insurers are not merely drawing off the healthier patients, leaving the sick–or those predisposed to be sick–with high-cost policies that discourage both the insured and the insurer.

Meanwhile, back in Missouri

Health care is expected to be a primary theme in Governor Blunt's State of the State speech January 24th, and a major focus for the legislature, but those who are hoping to see an expanded approach to health care are likely to be disappointed. In Republican-controlled Jefferson City, members of the majority party would likely draw concerned looks from their colleagues for even uttering the phrase “universal coverage”.

Though Governor Mitt Romney and Governor Blunt appear to be close politically, the two diverge on policy.

Already the Missouri legislature is calling for tax cuts; thanks to a coffer that is slightly more full ($300-$500 million, depending on who you ask) than last year–though far from overflowing. Much of it due to the several hundred million in reduced state spending when tens of thousands were chopped from the Medicaid roles last year. The legislature is currently examining ways to restructure the Medicaid program that covered many Missourians lacking health coverage.

There are proposals to expand some programs to cover more children and disabled workers, but much of the focus in the state program is on incentivizing healthy living and "wellness".

The Futute

As health care costs continue to skyrocket, more and more families will be forced to make cuts simply to afford health insurance. Some families are seeing rates increase by hundreds of dollars annually.

In December, a writer for the conservative weekly magazine The National Review expressed his shock and dismay that his monthly premiums were being raised 81% on January 1st.

CHRISTMAS PRESENT [John Derbyshire]?My health insurer has just notified me, in a brief form letter, that my monthly premiums are to rise from $472.33 to $857.00 on January 1st. That's an increase of 81 percent. ***E*I*G*H*T*Y*-*O*N*E* *P*E*R*C*E*N*T*** Can they do that? I called them. They sound pretty confident they can. Ye gods!

In a meeting this week that must have Mother Jones spinning in her grave, the Service Employees International Union's (SEIU) president, Andrew Sterm and the director of the Business Roundtable, which represents major national corporations, came together to propose a health care expansion similar to the governors' plans.

Romney and Schwarzenegger's proposals, along with new coalitions of labor and corporate business interests have moved the sticks on health care. The debate is no longer black and white, private insurance versus "socialized medicine". Growing coalitions with members as diverse as the conservative Chamber of Commerce and the liberal Families USA are a sure sign that the health care landscape is evolving.

It's highly unlikely that businesses will continue to shoulder the growing burden, and it will likely be the key to the viability of plans like the governor's plans. Push-back from business interests could, in fact, provide a more persuasive argument for "government-centric" universal health care than many progressive organizations could muster.

The health care of tomorrow could be quite a world away from the complex system of today.