This chapter provides the background and an overview of the debate concerning national health insurance and the issues surrounding the provision of universal health care in the United States. A discussion of the implications of universal health care for private insurance carriers and other stakeholders is followed by a review of the criticisms being directed at current efforts to reform health care in the U.S. A brief summary of the research concludes this chapter which is followed by a more complete description of the study's methodology in chapter three below.
Background and Overview
A strictly literal definition of universal health care would mean that everyone, including illegal aliens, all children irrespective of their financial or legal status, and those with preexisting conditions, for example, would be equally entitled to health care services, a situation that may appear as pie-in-the-sky but which is closer to reality than many observers might believe. In fact, a popular misperception currently exists concerning just how much health care is already being provided to those who cannot afford to pay for it in the form of national health insurance. The costs associated with providing current levels of health care through a convoluted system of providers and funding, though, make the provision of such care very costly and therefore scarcer for a growing number of American consumers. For instance, a recent essay by Berkowitz (2006) asks, "Why is there no national health insurance in the United States? The answer is that there is national health insurance in the United States and quite a lot of it. The problem lies in the fact that this country has too much health insurance -- making our health care system very costly -- and too little -- limiting access to health care to well over forty million people" (p. 1218). Furthermore, the current approaches to providing health care coverage to employees are heavily burdened by the need for some employers to provide health care coverage for their retirees. According to Champlin and Knoedler (2008), "Companies have moved away from the defined benefit pension in favor of the defined contribution plan. Part of this move has been an effort to avoid offering health benefits as part of the retirement package. Still, several high profile corporations retain substantial obligations to both current and retired employees" (p. 914). Citing as good examples General Motors (which provides health care coverage to 750,000 current and former employees), and Ford (which must cover about 560,000), these authors conclude that, "While some employers continue to pay most or all of the cost for individual coverage, the current trend is for employees to pay a higher percentage of the monthly premium. Only seventeen percent of employers still pay the full cost of health care coverage for individuals and only six percent pay the full cost of family coverage" (Champlin & Knoedler, 2008, p. 914). This trend has placed even employer-provided health insurance beyond the means of many Americans and policymakers are faced with these as well as a broader spectrum of problems that have been identified time and again over the years as efforts to provide equitable access to health care have come and gone.
In fact, the effort to provide health care to all Americans is not a new initiative but is rather a continuation of a century-long attempt to provide health care consumers with the level of care they need while balancing the costs involved. In many cases, these efforts have involved some type of national health insurance which mixed results. Notwithstanding the most recent efforts of the U.S. Congress and President Obama to pass the national Health Care Reform Act, prior efforts from 1970 to 2000 were marked by a swing away from universal health care. In this regard, Berkowitz notes that, "Although the nation has made periodic surges toward national health insurance, the result has never amounted to universal access. In fact, we have moved further away from this ideal in the last third of the last century" (2006, p. 1218).
Although the Health Care Reform Act has passed congressional muster and awaits signature by the president as this project is being researched, it faces a constitutional challenge by a growing number of institutional critics and taxpayers alike but it can be assumed that the bill will pass in substantially its existing form soon. Amid the media hoopla, though, these critics cite a number of constraints and weaknesses in the proposed law that will make it untenable over the long-term and highly costly in the short-term. According to a recent analysis by Bowman (2010), "Supporters have praised President Obama's health care reform bill as a historic landmark in our nation's history -- and so it is, but not for the reasons that many of them claim. The concept itself is not the problem. In fact, it is even commendable" (para. 2). As noted above, the health care reform initiative being promoted today is a continuation of a 100-year trend to this end, but as also noted above, critics suggest that the current legislation is fundamental flawed from a conceptual perspective. In this regard, Bowman adds that, "Providing affordable health care to an entire nation is a noble goal, and that is basically what the bill is trying to achieve. But before we jump onto the bandwagon of reform, perhaps we should take a closer look at how the bill will affect the nation" (para. 2).
This closer examination reveals that during a period of economic downturn, the United States government is seeking to establish additional and potentially onerous mandates on the states and individual citizens that will raise taxes and require the several states to increase funding for health care services (Bowman, 2010). Some estimates of the additional costs of the Health Care Reform Act exceed $500 billion over the next decade, with a significant portion of this money being derived from levies on Medicare and taxpayers (Bowman, 2010). As noted above, besides the funding mechanisms that are involved in the proposed law, there are serious questions concerning the constitutionality of its provisions. In this regard, Bowman notes that, "The bill, when fully implemented, will require all individuals to purchase health care or risk being fined by the government. Several states have vowed to actually sue the federal government over this point, claiming that it infringes on the constitutional rights of citizens. How can the government expect to force us to pay for health care that they themselves provide?" (2010, para. 2). In response to these charges and others, the White House press release concerning the provisions of the Health Care Reform Act emphasizes that:
1. It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today. This helps over 31 million Americans afford health care who do not get it today -- and makes coverage more affordable for many more.
2. It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.
3. It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
4. It will end discrimination against Americans with pre-existing conditions.
5. It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years -- and about $1 trillion over the second decade -- by cutting government overspending and reining in waste, fraud and abuse (Health care, 2010, para. 3-4).
Nevertheless, some critics cite the lack of a so-called public option (meaning that consumer choices for health care are limited to private insurance carriers) in the Health Care Reform Act which they regard as an essential element if the legislation is going to pass a review of its constitutionality (Bowman, 2010). Instead of a public option, the current approach mandates a government option only. According to Bowman, the government option is "a rationed plan with benefits and treatments chosen by a government committee. The problem with that option is, you have no say in the benefits that are given (or withheld), and there is no appeals process if you disagree. In addition to this, according to the bill itself, no company can sue the government for price-fixing, and no 'judicial review' is permitted against the government" (2010, para. 3). Despite these constraints and drawbacks, the Health Care Reform Act is set to become the law of the land in the near future and the implications for private insurance carriers and American healthcare consumers is profound, and these issues are discussed further below.
Implications of Universal Health Care Coverage
Universal health care plans inevitably confront the harsh realities involved in hammering out viable approaches to coordinating administrative and payments methods…