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68 Percent of Americans Favor Mandatory Health Coverage

by January 19, 2008 blog

As health care generates debate in this year’s presidential campaign, about 68 percent of Americans say individuals should be required to have medical insurance, with government help for those who cannot afford it, a survey released on Tuesday found.

According to the survey by The Commonwealth Fund, an independent foundation, health insurance mandates are supported by 80 percent of Democrats, 52 percent of Republicans and 68 percent of Independents.

The group also points out that while all leading Democratic and Republican candidates want to expand health coverage through the private insurance market, there were several key differences…

About 47 million people in the United States do not have health insurance.

Both Republican and Democratic candidates, with the exception of Kucinich, envision a health insurance system that continues to be structured around private insurance markets with a supporting role played by public insurance programs.

The candidates diverge significantly, however, on the way this system should operate.

None of the Republican candidates would require that people have health insurance. On the Democratic side, Sen. Hillary Clinton and former Sen. John Edwards would require that all Americans eventually have coverage.

Obama would require coverage only for children, though he would consider an individual mandate for adults if substantial numbers of people do not buy coverage that is deemed affordable. Sen. Barack Obama would not seek to cover adults and would only require that children have coverage.

A Commonwealth Fund survey of adults age 19 and older, conducted from June 2007 to October 2007, finds that large majorities of the public, regardless of political affiliation or income level, say that the candidates’ views on health care reform will be very important or somewhat important in their voting decision.
Moreover, they believe employers – long the cornerstone of the health insurance system – should retain responsibility for providing health insurance, or at least contribute financially to covering the country’s working families. A majority of adults would also favor a requirement that everyone have health insurance, with the government helping those who are unable to afford it; support for such a requirement, however, is not strong and varies by political affiliation, geographic region, and income.

There is overwhelming agreement that financing for health insurance coverage for all Americans should be a responsibility shared by employers, government, and individuals. (The Public’s Views on Health Care Reform in the 2008 Presidential Election)

Health spending in the United States is projected to increase from 16 percent of gross domestic product (GDP) in 2006 to 20 percent in 2016 – from $2 trillion to $4 trillion in 10 years.

At the same time, the number of people who are uninsured is rising sharply, including a growing proportion of middle-income families. More and more middle class families are affected every day, more every year. It’s very significant that the number of uninsured people climbs every year and more and more middle-class people are affected. Its effect on our economy is dramatic.

While rising costs are putting all sectors of the economy at risk, the nation currently lacks a concrete, realistic plan for adopting a different approach that could achieve savings and improve value.

The reasons are clear and numerous. The number of Americans without health insurance has continued to climb: 47 million people were uninsured in 2006, an increase of 8.6 million from 2000.
In addition, an estimated 16 million nonelderly adults are underinsured as a result of high out-of-pocket health costs relative to income.

And although employer-provided health insurance remains the predominant form of coverage for U.S. workers and their families, rapid growth in health care costs and premiums has weakened the ability of many firms to offer comprehensive coverage and for many families to afford it. Employers – particularly small companies – are passing more costs to their employees or eliminating coverage altogether. (The 2008 Presidential Candidates’ Health Reform Proposals)

With the presence of an individual mandate, it will be critical that health plans are affordable and that the mandate is enforceable. Even the ability of the Republican proposals to expand coverage will depend on whether people have access to affordable health plans. Edwards is the only candidate who has stated how he would enforce an individual requirement to have health insurance.

None of the Republican candidates has identified a source of financing.

The leading Democratic candidates would either roll back the tax cuts of the past few years or allow them to expire for households with incomes above $200,000 (Edwards) and $250,000 (Clinton and Obama).

They have also identified other more minor sources of financing, as well as savings achieved through improved efficiency.

While Edwards was the first candidate to roll out a health care plan, the other candidates have followed his lead and their offerings have come close to his ideas.

Senator John Edwards has just set a fine example
At first glance, the Edwards health care plan looks similar to several other proposals out there, including one recently unveiled by Arnold Schwarzenegger in California. But a closer look reveals extra features in the Edwards plan that take it a lot closer to what the country really needs.

Like Mr. Schwarzenegger, Mr. Edwards sets out to cover the uninsured with a combination of regulation and financial aid. Right now, many people are uninsured because, as the Edwards press release puts it, insurance companies “game the system to cover only healthy people.” So the Edwards plan, like Schwarzenegger’s, imposes “community rating” on insurers, basically requiring them to sell insurance to everyone at the same price.
Many other people are uninsured because they simply can’t afford the cost. So the Edwards plan, again like other proposals, offers financial aid to help lower-income families buy insurance. To pay for this aid, he proposes rolling back tax cuts for households with incomes over $200,000 a year.

Finally, some people try to save money by going without coverage, so if they get sick they end up in emergency rooms at public expense. Like other plans, the Edwards plan would “require all American residents to get insurance,” and would require that all employers either provide insurance to their workers or pay a percentage of their payrolls into a government fund used to buy insurance.
But Mr. Edwards goes two steps further.

People who don’t get insurance from their employers wouldn’t have to deal individually with insurance companies: they’d purchase insurance through “Health Markets”: government-run bodies negotiating with insurance companies on the public’s behalf. People would, in effect, be buying insurance from the government, with only the business of paying medical bills — not the function of granting insurance in the first place — outsourced to private insurers.
Why is this such a good idea? As the Edwards press release points out, marketing and underwriting — the process of screening out high-risk clients — are responsible for two-thirds of insurance companies’ overhead. With insurers selling to government-run Health Markets, not directly to individuals, most of these expenses should go away, making insurance considerably cheaper.

Better still, “Health Markets,” the press release says, “will offer a choice between private insurers and a public insurance plan modeled after Medicare.” This would offer a crucial degree of competition. The public insurance plan would almost certainly be cheaper than anything the private sector offers right now — after all, Medicare has very low overhead. Private insurers would either have to match the public plan’s low premiums, or lose the competition.
And Mr. Edwards is O.K. with that. “Over time,” the press release says, “the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan.”

So this is a smart, serious proposal. It addresses both the problem of the uninsured and the waste and inefficiency of our fragmented insurance system.