Universal Health Care

Reading the news yesterday, I came across an item that said presidential candidate and New Mexico Gov. Bill Richardson said he could create universal health care in this country -- during his first year in office! Since he's in his sixth year as chief executive of New Mexico, with a Democratic majority in both the House and Senate, and hasn't created universal health care here yet for some two million people, I was fascinated to learn the details.

The most authoritative and complete (I use that word advisedly) explanation I could find was on the Richardson for President web site: http://richardsonforpresident.com/blog/seiu2.


The guts of it appears to be to allow people 55 and older to buy into Medicare and to allow "working families" (how about working singles?) to buy into "the same plan members of Congress enjoy." Well, I've read lots of references to candidates vowing Americans will get the same kind of health care available to members of Congress. But it occurred to me that I didn't know what that congressional health plan was. So I did a little Googling and found that members of Congress can buy into the federal employees health plan -- which gives several choices of insurers and plans, which vary from state to state. So I'm afraid I can't give you any set guaranteed benefits and premium costs.

Of course, it occurs to me that, in order to enjoy exactly the same kind of health care members of Congress get, we'd all have to be given six-figure incomes and the clout that comes from voting on matters dear to the hearts of the people providing that health care.

But never mind that. It's true, the opportunity to buy into a large health plan would make health insurance more affordable to many people. There are questions, though. If you're self-employed, do you pay only the employee portion of the premium or the entire portion? And some people already have health coverage available at work, but choose not to get it because they don't feel they can afford even the portion of the premium that comes out of their pay now. And how about unemployed people? Or people who lose their jobs because of ill health, no longer have income coming in, and are faced with mounting medical costs that aren't covered by their insurance? Which do they pay first: their co-pays or the premiums to ensure they get continued coverage?

Well, there's a simple answer in Richardson's health plan to make sure everyone gets covered: Pass a law requiring everyone to get health insurance. Just like auto insurance is required by law. And we know there are no uninsured drivers on our roads. Right?

This proposal -- not all that different, by the way, from those I've seen proposed by other candidates -- seems to stem from efforts in Massachusetts to provide universal coverage. That state requires everyone to have health insurance. I tried to find out how well that is working, only to discover that requirement won't take effect until July 1. The penalty for not having health insurance is $200 in tax penalties next year, and an amount equal to half of a year's premium cost of the most affordable plan. (http://amednews.com, 4/2/07)

But how do you enforce it? With auto insurance, at least there's some pretense of checking to see if you have insurance when you renew your license or auto registration. How do you do it with health insurance? Check for coverage when you go to get health care and then refuse it if a person doesn't have insurance? Wait a minute... that's how the current system works.

OK. Suppose you build in help to make this affordable for everyone. What will that cost and where will the money to fund it come from? Candidate John Edwards has estimated providing coverage for folks without health insurance now would cost about $120 billion/year. That would be paid for through revoking tax cuts that people making more than $200,000 have gotten in recent years, Edwards said. (Bloomberg News, 3/26)

I haven't found any price tag provided by Richardson.

But I've seen news reports in which he claimed universal coverage could be funded by money now spent on the war in Iraq. That assumes, of course, he'd substantially reduce money spent on troops in Iraq, or pull them out completely. It also implies something else. Federal budget deficits have been growing under the current administration, at least partly due to spending on the military and tax cuts given under the Bush administration. So if Richardson plans to use money now spent on Iraq for health care, that suggests he would continue the same level of deficit spending.

The only alternatives to continuing deficits, it seems, would be to (a) increase taxes, or (b) cut spending elsewhere.

I also read a vague reference that Richardson would cut administrative costs to help pay for the additional coverage. Hard to imagine how he could do that with the current system. Even if the federal health plan had contract requirements that only a certain percentage of the money could be used on administrative costs, that doesn't touch the administrative costs suffered by health providers who have to keep hiring more people to manage all the paperwork generated by a plethora of health plans.

Of course, using the current system is politically attractive because it would generate less opposition from insurance companies and others who make a profit from the current system.

So, explain to me again how he hasn't managed to put such a system into place in New Mexico, substituting the state employee health coverage for the federal plan that people could buy into?
Yet he could do it on the federal level within a year?