Health care reform dominates the news and public debate, and whatever reform is enacted (if any) will far from solve all of our nation's health care problems. Health care is an enormous, and enormously complex issue, and many people in both parties have said many things, some true, some misleading. This discussion guide is intended to help you understand the issue and the many choices for possible reform.
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Choice 1
Use free market competition to maximize personal choice while making the system more efficient
- Require that all Americans who aren't already covered buy their own insurance but let them make their own choices in the marketplace.
- Offer tax credits and tax-free medical savings accounts to make it easier for people to buy individual coverage.
- Allow private insurers to create basic, high-deductible policies that would cover the most common problems and provide government subsidies and tax deductions to make coverage affordable for small businesses and people who need to buy their own insurance. People would still be insured against catastrophic illnesses, but would have to pay more out-of-pocket for other health services.
- Encourage more employers to provide coverage through HMOs and other forms of managed care to ensure competition.
- Encourage small businesses to join together in insurance pools to negotiate for better rates.
- Encourage the use of lower-cost generic drugs and allow people to buy approved drugs from Canada and Europe. Charge patients more if they insist on brand-name drugs.
- Work with industry and all interested parties to reduce costs.
Arguments for:
- This approach emphasizes personal responsibility and choice, private competition and limited government, basic values America has embraced throughout its history.
- The free market is the best way to keep health costs down, and if the health care system becomes more efficient, we can provide more services for more people, without spending more money.
- The only way to control costs is by allowing insurers, health care professionals and patients to make decisions about what they really want and need. That means empowering patients to set aside money tax-free for medical care and allowing them to seek out cheaper alternatives, like drugs from other countries. If Americans paid a larger share of health care, they would be more likely to limit their consumption of care.
Arguments against:
- Under managed care, decisions about treatment are often made based on what’s cheapest, not necessarily the best.
- This will require people to make critical, complicated choices when they’re sick and at their most vulnerable.
- This approach undermines our commitment to community and belief in government’s role in taking care of low-income children, older adults and people with disabilities – basic values America has embraced throughout its history.
- Due to the troubled economy, millions of people have lost their jobs and their health care. Government programs like Medicare, Medicaid and the State Children's Health Insurance Program provide a critical safety net in a damaged economy.
Discuss this choicework Choice 2
Expand on the current system to fix many major problems without the risks of radical change
- Require employers to offer health coverage to all their workers, even low-wage and part-time employees. Offer tax incentives to businesses to cover the cost.
- Add a "public option," a government insurance plan to fill in the gaps and cover those who aren't covered by private insurance or other government plans.
- Develop health insurance pools or cooperatives to allow individuals including the self-employed and employees of small businesses to choose from a variety of insurance companies in active competition with each other. Some federal subsidies and tax incentives could be provided.
- Extend the Children’s Health Insurance Program cutoff age from 18 to 25.
- Expand Medicaid eligibility to 133 percent of the federal poverty level ($14,500 for an individual and $29,500 for a family of four) so that it covers more Americans funding and raises the income cutoff to cover the working poor.
- Make insurance “portable” so people can keep the same policy if they change jobs.
- Open up the federal employee health insurance program to allow individuals to buy coverage at favorable rates.
Arguments for:
- By expanding existing programs and employer-provided insurance we can cover most of the uninsured.
- This is the least disruptive way of attacking the problem – it won’t require massive changes in how the health care system operates or how people get their insurance.
- People will still be able to pick their own doctors and health plans and get the same quality of care.
- This makes our most vulnerable citizens, children and older adults, a priority. This helps children grow up to be healthy, productive adults and ensures older Americans get the care they need.
Arguments against:
- This will be expensive at a time when the federal government already has a budget deficit, and we may still not be able to insure everyone.
- Medicare is already at risk and will likely go broke as it deals with aging baby boomers. Adding more people to Medicare will just cause the program to collapse more quickly.
- This will do nothing to control health care costs, which are rising at an outrageous rate, and may well increase overall health costs rather than reduce them.
- Requiring employers to provide coverage will be expensive, and even if the government helps with the cost, we’ll still impose a huge paperwork burden on businesses.
Discuss this choicework Choice 3
Create a national health care system to make sure everyone is covered
- Create a Medicare-style ‘single payer’ system, where the government provides health insurance for everyone.
- Allow patients to get a standard list of covered health services from any doctor or hospital in the program.
- Raise taxes or repeal existing tax cuts to fund the program.
- Impose stricter government controls on the prices that health care providers can charge.
- Tie the new health insurance system into existing government programs to promote good nutrition, mental health awareness and exercise.
Arguments for:
- Health care should be a right, not a privilege for those lucky enough to have a good job or be a certain age. This approach is the only way to guarantee that everyone gets medical care.
- Countries with national health care systems often have good health care at a lower cost because the government can make bulk purchases of drugs and control costs.
- This will actually reduce paperwork. Doctors and hospitals will only have to deal with one set of forms and one government agency, rather than dozens of private companies and government agencies, all with different rules.
- Any new taxes will be offset by the savings earned when employers and workers no longer have to pay insurance premiums.
Arguments against:
- Under this plan, a government bureaucracy tells you what health care you can have and when you can have it. In Canada and other countries it’s common to wait months for elective treatments or surgery.
- This will require steep tax increases. All health care costs now paid by private industry would be taken on by taxpayers.
- The Canadian and European health care systems are expensive and those nations struggle to cover their costs without breaking the budget.
- Health costs will still be a burden to businesses, which will trade a health insurance plan they can control for a health care tax they can’t.
Discuss this choicework
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