PETER O. ZIERLEIN
During the campaign Barack Obama has talked about healthcare on and off–more on during the primary campaign, when Hillary Clinton pushed him about whether people should be required to buy insurance; more off when healthcare has been eclipsed as a red-hot issue, such as during the financial crisis. When he has talked about healthcare, his oratory has been short on details and punctuated by twin themes: a call for universal coverage and for reducing the average family’s insurance premium by $2,500. Obama has consistently stuck to those points, even though there has been little media examination of what they really mean and, more important, whether they are achievable.
For starters, Obama’s plan is not a true universal health insurance model like the ones found in the rest of the developed world, a point many people do not understand because the word “universal” has been so misused in the campaign by candidates as well as the media. In the national health insurance systems of other countries, citizens are entitled to healthcare as a basic right, and everyone pays taxes to fund the services they receive. Those systems are universal and accountable to the public, not to shareholders of private companies, which is the case in the United States. Medical costs are more tightly controlled, and most of those truly universal systems deliver better care at far less cost than the US system. Obama has repeatedly rejected an immediate shift to such a system, generally called “single payer” in America; in an August town hall meeting in Albuquerque, he said, “Given that a lot of people work for insurance companies, a lot of people work for HMOs, you’ve got a whole system of institutions that have been set up.” When a voter asked, “Why not single payer?” Obama replied that people don’t have time to wait for such a truly universal plan: “They need relief now. So my attitude is, let’s build up the system we got, let’s make it more efficient. We may over time–as we make the system more efficient and everybody’s covered–decide that there are other ways for us to provide care more effectively.”
Obama and his health advisers propose to make the system more efficient and cover everybody by enhancing the country’s so-called public-private partnership. In effect, the Obama plan, by offering subsidies to those who are uninsured, would deliver more business to companies already profiting handsomely from the peculiarly American system of health insurance. If his plan survives the legislative process and all works according to his policy prescriptions, somehow the country will get closer to universal coverage. Millions of people, however, will still be left out–unable to qualify for the public programs yet also unable to afford the ever increasing premiums of private ones. The exact number was a matter of contention during the primaries.