The governor of Massachusetts has some new ideas for health care that, if nothing else, may help stimulate public discussion of the problem and our options for dealing with it.
The U.S. Census Bureau reports that 15% of U.S. residents lack health insurance, not being old enough to qualify for Medicare, poor enough to qualify for Medicaid, fortunate enough to have employer-provided coverage, or willing or able enough to pay for it on their own. Some, like Tyler Cowen at Marginal Revolution, are not terribly alarmed by this, arguing that many of these uninsured are undocumented immigrants (more recent evidence on which here), college students, or people whose true status has been miscounted in the Census Bureau’s surveys. Others, like Econlog, appear unconvinced that the situation has resulted in significant untreated health problems.
Whatever your interpretation of the Census Bureau statistics, there is no denying how the system works in practice when the uninsured need urgent health care. They show up in the nation’s hospital emergency rooms and trauma centers, where, if they can’t be turned away, the hospital or the state ends up stuck with the bill. California Physician reported last fall that California emergency rooms lost $325 million in 1999-2000, $390 million in 2000-2001, and $460 million in 2001-2002. And California Healthline claimed that 70 emergency departments and trauma centers in California have closed since 1990, a period during which the state’s population was growing dramatically.
It is hard to see how this arrangement for footing the bill for the uninsured could represent an optimal policy. Governor Mitt Romney (R-MA) has some new suggestions for how to approach this problem that in my opinion warrant a careful look. The governor’s plan would require those with no insurance who use medical care to pay their own way, or, if not, risk having the state recoup any medical costs through state income taxes or payroll deductions. The plan includes a “safety net” feature to provide state assistance to purchase health insurance for those with limited incomes but not poor enough to qualify for Medicaid.
The plan is not without its critics. Pinko Feminist Hellcat lets rip with
I have an even bigger problem with the tired rhetoric that gosh, these lazy poor people just don’t want health care, and we will have to beat them with a stick to get it….I don’t know of any folks who would prefer to forgo health insurance and hit the ER, and the rhetoric that would suggest otherwise is breathtakingly ignorant.
FullosseousFlap’s Dental Blog has a no less full-throated condemnation from what appears to be more of a right-wing perspective:
In an era where citizens demand less governmental intrusion in their lives here comes a child-support – alimony type government coercion plan to make sure you pay your medical bills….This is not a conservative healthcare plan at all. It is government intrusion.
And yet there are a number of others, certainly themselves hardly at the center of the political spectrum either, who are prepared to take Romney more seriously. The Boston Globe quotes Sen. Edward Kennedy (D-MA) as describing Romney’s plan as “a healthy step forward”, though adding “details of the benefits offered and the level of cost-sharing individuals will face are crucial to understanding this proposal.” And the Boston Herald claims that Romney’s plan was developed in consultation with the conservative Heritage Foundation.
What sort of a plan could end up getting Senator Kennedy to agree with the Heritage Foundation? The proposal would have a considerably different character as you consider varying the cutoff specifying who qualifies for the safety net and how much government assistance is provided for them. If you set those limits so that all but the richest households qualify for substantial assistance, the plan becomes in effect a universal health care coverage which Senator Kennedy has long championed. On the other hand, if you reduce the safety net to virtually nothing, the plan has a sort of Charles Dickens, throw the poor in jail when they get sick flair to it that even Ebeneezer Scrooge might come to admire.
As .08 acres (and a Donkey) observes, the devil is most assuredly in the details here, and once one specifies particular dollar values for these critical parameters, the battle lines will again no doubt be drawn across familiar ground, with Senator Kennedy and the Heritage Foundation eyeing each other from opposite sides of the issue.
Even so, I count it as progress of sorts if we might in this fashion find ourselves at least able to agree on what we want to buy, leaving just the little matter of haggling over the price. A proposal like Romney’s strikes me as a constructive way to frame a public discussion of exactly where America stands on who should pay the medical costs of the uninsured.