Our system lavishes the best health care in the world on the people who can afford it, but it becomes more expensive and less accessible by the year.
As the health care debate draws to a climax, we're hearing talk that is bound to make many people uneasy about changing the current system. Business groups say that universal health care will create an intolerable burden for small businesses and put many successful companies at a big disadvantage. Insurance groups run ads that are designed to make people worry that health care reform will leave them with poorer coverage than they have now. And doctors' offices are filled with materials about how universal coverage will damage the quality of health care. Some doctors are telling patients, as they provide a particular service, "I don't know that this would be covered if we had a national health care plan." That's pretty potent stuff.
One thing we have to keep in mind is that the U.S. is the only advanced industrial democracy in which every single person does not have health insurance. And it's not that Denmark and Japan and Australia spend more money than we can afford on health care -- in fact, we pay 35 to 40 percent more than they do for a system that excludes an estimated 38 million Americans. The experience of these other countries shows that there are many different ways of organizing national health care. There's no question that we can figure out a system that will work for us.
An issue that has many people worried is the payment mechanism for a national health care system. There are several possibilities, but the so-called employer mandate, which the Clinton administration favors, has a lot going for it. Under the employer mandate, an employer will pay a specified percentage of the costs for health coverage and the employee will pay the rest. That's the way it works with Social Security, and it's the way most people pay for their health insurance now. Small companies for whom the health premiums would be an unreasonable burden will receive subsidies. Since most workers are already insured at their place of business and since at least one member of most U.S. families works, this system would take advantage of an existing mechanism to provide nearly universal coverage. The employer mandate mechanism would be efficient, and it would require no new bureaucracy. But opponents are saying that it would be an unfair burden on American businesses. I don't see that.
Many employers now pay for their employees' health care -- it is already a cost of doing business -- and the employer-mandate plan calls for the federal government to help the smallest businesses with their costs. What about the rest? Wouldn't universal healthcare put them at a competitive disadvantage? Not at all.
The owner of a large pizza chain was on national television a few weeks ago talking about how he'd like to provide health benefits for his employees, but he simply can't afford it. If he were obliged to, he said, he would have to fire people, and the future of his business might be threatened. What he didn't say was that if national health care premiums forced him to raise the price of a large pizza by 15 cents, his competitors would be in exactly the same boat. Everybody's pizza would go up by the same amount, and no one would be a loser relative to his competitors.
It's our present system that puts nice guys at a competitive disadvantage. Suppose you really want to give your employees health insurance because you appreciate their loyalty and hard work. If you competitors don't also provide it for their employees, you will have to make up for the money you spend by putting less cheese on your pizzas than the chain across the street or finding a way to get thinner slices of pepperoni. That really could have an impact on your sales. Your generosity takes money out of your pocket, and it puts money in the pocket of your competitor who cares less about the well-being of his employees. The employer-mandate plan for financing health care would level the playing field.
But healthcare is not simply a question of economics -- it's also a moral issue. Our system lavishes the best healthcare in the world on the people who can afford it, but it becomes more expensive and less accessible by the year. Millions who now have health insurance watch their benefits diminish year by year. And they wonder when they will lose all coverage because they have changed jobs or someone in their family has developed an "uninsurable" condition. At some point, every other advanced industrial democracy has decided that people who live in a humane society should not have to worry about getting medical care when they are sick. It's time for us to make that decision, too.