Arguments mount for a national healthcare system

Some reformers say a government-run system has become an 'economic necessity.'

from the March 3, 2008 edition

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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.

Employers would have to offer health coverage at least as good as this plan, or, alternatively, pay 6 percent of payroll into the national pool to cover their employees.

The tax deductions currently given employers on healthcare costs would be eliminated in favor of a new standard income-tax deduction for individuals with health insurance.

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."

But a survey by the Harvard School of Public Health finds that the public is not so scared of that term anymore. Asked if socialized medicine would be better than the present system, 45 percent said "better." Another 4 percent said "about the same" and 12 percent "who knows." Only 39 percent ticked off "worse."

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.

One reason could be what Sara Robinson, a North Vancouver analyst, calls the many "myths" about Canada's system. One myth is that it is less efficient. Rather, she argues, shareholder profit, inflated CEO salaries, and top-heavy administration in the US system siphon off 20 to 24 percent of healthcare spending.

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.

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