Arguments Mount for a National Healthcare System (Christian Science Monitor)

...In the current campaign season, Senator McCain calls for dozens of reforms to bring down costs and make expenditures more effective in health results. And he states, "we can and must provide access to healthcare for all our citizens." His proposals, though, don't fully embrace the uninsured.

Shannon Brownlee, a senior fellow at the centrist New America Foundation, charges that McCain is "so wedded to the free market that he fails to recognize that there has been market failure" in the healthcare industry.

Democratic presidential candidates Sens. Hillary Rodham Clinton and Barack Obama are more ambitious in their proposed reforms than McCain. They both promise, if elected, to provide guaranteed, affordable care for all Americans.

Both of their proposals have taken key elements from a plan of Jacob Hacker, a political scientist at Yale University in New Haven, Conn. Professor Hacker's template, outlined in an Economic Policy Institute briefing paper, notes: "America's $2.2 trillion-a-year medical complex is enormously wasteful, ill-targeted, inefficient, and unfair. The best medical care is extremely good, but the Rube Goldberg system through which that care is financed is extremely bad – and falling apart." He calls the runaway costs a "grave threat" to the security of family finances and to corporate America's bottom line.

The Hacker plan combines the current employer-based system with a new federally administered insurance pool similar to Medicare, the popular program for older Americans. This new pool would be funded by premiums and copays charged to individuals and employers who sign up, as well as government subsidies. Individuals would automatically be enrolled, either at work or when they seek care. Premiums would be capped, with subsidies for lower-income families. ...

Hacker was delighted last month when an analysis of his plan by the Lewis Group, a nonpartisan consulting group, held that his proposal would cover 99.6 percent of all Americans without raising total national health spending. Indeed, it would save more than $1 trillion over 10 years, the report held.

None of the leading presidential candidates call for a single-payer system, as in Canada. That may be in part political expediency, considering what is possible. Republicans sometimes call Democrat health plans "socialized medicine." ...

Hacker doubts if Americans would go "in one fell swoop" for a single-payer system where individuals choose their own doctors, but government pays the bill. ...

Canada, says Ms. Brownlee, author of a new book, "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer," spends about 16 percent of every dollar on administrative costs.