Last week Sen. John Edwards became the first presidential candidate in U.S. history to propose solving the problem of the uninsured by making health insurance mandatory. Although his proposed health care mandate is limited to children and young people -- all those under the age of 21 -- it offers the most promising way forward for eventually covering all 41 million uninsured Americans, and it marks a major turning point in our nation's health care debate.
The United States spends more on health care per capita than any other nation, yet one in seven of our citizens, and 12 million children, still lack basic health insurance. There are essentially only two ways to overcome this and achieve universal health insurance. One is to adopt a single-payer, government-run system, which is the norm in Canada and most of Europe. Such a system would have the government acting as the purchaser, administrator and health care decision-maker for all Americans. But a government-run approach has been flatly rejected by the American people time and again, despite the best efforts of five presidents, from Truman to Clinton.
The other -- and far more promising -- path to universal coverage is to approach health insurance as we approach car insurance: Make it mandatory. In essence, all Americans should be required to purchase their own health insurance from among competing private providers, with the government providing subsidies to those who need them.
The first and most obvious benefit of an individual mandate is that it would achieve universal coverage. By contrast, neither President Bush's proposal for refundable health care tax credits nor the various plans put forth by other Democratic candidates could meet this test, because all approach the problem in a piecemeal fashion.
The promise of "universal coverage for universal responsibility" goes beyond solving the problem of 41 million uninsured Americans. Structured correctly, such a policy would also bring down health care costs for most Americans (by virtue of forcing a large number of relatively young and healthy Americans into health care pools), and offer citizens more health care choices. It would also provide all Americans who now have insurance something they don't now have but badly want: the ability to take their health plan and doctors with them from job to job.
One of the overwhelming benefits of mandatory coverage is that health insurance would gradually become citizen-based instead of employer-based, enabling all citizens to select and keep the health insurance provider of their choice and to take advantage of group rates, regardless of their employment status. This would help American workers at all levels: from the highly compensated executive changing jobs to the single mother working two part-time jobs to the independent contractor who can't afford the prohibitive costs of getting insured in today's individual market.
For political reasons, it is understandable why Edwards would start by requiring health insurance for all children. After all, parents are spending the month of August making sure their children have the immunizations and physicals required to enter school in September. But if we force parents to meet these basic medical requirements, shouldn't we also make it easier for them to secure the health insurance necessary to comply with the law? And in a country that prizes the virtue of personal responsibility, is it really too much to expect parents to insure their children, especially if the government provides a helping hand for those who need it?
The logic of personal responsibility and of requiring all parents to cover their children raises the obvious question: Why not apply the individual mandate to all Americans? The Edwards campaign estimates that its plan would cover 21 million Americans who lack health insurance at a cost of approximately $53 billion a year. By comparison, both the Blue Shield of California Foundation and the Commonwealth Fund recently released independent analyses showing that by applying an individual mandate to all Americans, we could reach universal coverage for $70 to $75 billion a year. Is the value of covering the remaining 20 million Americans not worth the incremental cost of about $20 billion?
Although John Edwards is the first to propose mandatory insurance as part of his presidential platform, he is not the first presidential candidate to have endorsed the concept. Bob Dole, the 1996 Republican nominee for president, once co-sponsored legislation with the late Sen. John Chafee to require all Americans to secure health insurance by the year 2005. At the time, Dole and Chafee were joined by 18 of their Republican colleagues, half of whom remain in the Senate today. This suggests that John Edwards has not only put his finger on the most promising way to solve the problem of the uninsured but also on the approach most likely to garner bipartisan support.
Copyright 2003, The Washington Post