Can we have Universal

Can we have Universal - universal health care ROGER BYBEE...

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B arack Obama aspires to be a “transformative” president, with his hopes par- ticularly fixed on America’s finally achieving a universal health care system. But would his health plan go far enough to transform a system that has been dominated and distorted by for-profit insurers who maxi- mize profit by rationing care to patients, re- stricting doctors’ choice of treatments, and rais- ing premiums? Of course, the outlines of Obama’s plan will be profoundly changed by the legislative process, and it may be virtually unrecognizable once a finished product reaches the presidential desk. But it is a valuable start- ing point for discussing what is likely to suc- ceed, and what is likely to fail, in health care re- form. Obama has outlined a plan for universal cov- erage, cost restraints, and extensive choice for American health consumers, along with new regulations on for-profit insurers. However, the insurers will continue to claim a major role. By avoiding the risks of a direct collision with the tremendous power of the health insur- ance industry, the Obama plan fails to address the problem of effective cost controls needed to sustain coverage for all Americans. Passage of his bill would set off a perpetual tug of war be- tween insurers’ ever-rising premiums and the increasingly expensive goal of universal cover- age. Further, leaving private insurers in place largely forfeits the massive savings in excess ad- ministrative costs that could help to fund uni- versal health care and other priorities. On the positive side, the Obama plan also of- fers a public, Medicare-style option that some advocates of his proposal view as the potential incubator of a single-payer system, if sufficient numbers of Americans gravitate away from pri- vate insurance. If this provision can pass both houses, it will set off a high-stakes struggle. The for-profit insurers will work to circumvent new regulations that could force them to provide treatment for all potential enrollees and limit their administrative overhead. Some experts ex- pect that the insurers will attempt to turn the public program into a dumping ground for high-cost patients and will easily manipulate new regulations on other pernicious practices, triggering a new round of battles with health consumers and Congress. Eventually, these struggles could erode insurers’ legitimacy and exhaust all alternatives short of a single-payer system that dethrones the insurance industry. DIMENSIONS OF THE HEALTH CARE CRISIS T o evaluate the Obama plan and the nature of the battles it will generate, we first need to grasp the scope of the health care crisis. • Some forty-seven million Americans were already lacking health insurance before the economic meltdown. The sharp increase in unemployment is rapidly adding to their ranks.
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