Tuesday, April 21, 2009
The hardest group to sell on national health reform is those who don't desperately need it. That would include Americans who already have coverage through a workplace, about 160 million in all, and are reasonably happy with their deal.
The comfortably insured are always the target for scare-talk about rationing, loss of choice, higher taxes and government takeovers of health care. After all, they're the ones with something to lose, or so they've been led to believe.
Fifteen years ago, the Clinton administration unveiled a plan for universal health coverage, and its foes went to work. The insurance industry unleashed a battalion of negative advertising so effective that it has entered political lore. We speak of the Harry and Louise ads on TV.
Authoritative male voiceover: The government may force us to pick from a few health plans designed by government bureaucrats.
Louise: Having choices we don't like is no choice at all.
Harry: They choose.
Louise: We lose.
Of course, people covered by employers don't have unlimited choice, either. They pick from a pre-determined list of plans, if they're lucky enough to have more than one option.
And let's put in a kind word for government bureaucrats. They designed Medicare, and the beneficiaries love it.
Such realities get lost in the haze of half-truths. To win, reformers must avoid wonkery and answer this simple question: "What's in it for me?"
For starters, more money. Your company health plan does not come free. Part of your compensation package, its cost gets subtracted from your paycheck. Employer-provided health coverage cut cash wages by nearly 8 percent last year, according to the Bureau of Labor Statistics.
A bipartisan heath-care proposal introduced by Sen. Ron Wyden, an Oregon Democrat, and Bob Bennett, a Utah Republican, would put the numbers right under everyone's nose. It would work as follows:
You pick a private-health plan from a state-compiled list. You cover your premiums through an add-on to your taxes. In the first two years, your company must give you a raise for the cost of health benefits it no longer provides. (Thereafter, employers contribute to an insurance pool.)
The plan has another virtue in these days of job insecurity. It de-links coverage from place of employment.
Any rational program would also curb waste. America spends $8,000 per person on health care, about twice the rich-country average. There's lots of room to save money without sacrificing quality. Bear in mind that America's tendency to over-treat people does not produce outcomes superior to the best European systems. And lowering premiums ends up as money in your pocket.
What about freedom to choose providers and treatments? Well, private insurance also sets rules on what it will cover and typically provides lists of preferred doctors and hospitals. If your plan lets you go out of the network, you have to pay extra for the privilege. Nothing wrong with that, but we must drop the romantic notion that private coverage affords total freedom at popular prices.
Contrary to the propaganda, a government plan doesn't tell you what you can have. It tells you what it will pay for. You can buy whatever you want with your own money. And any well-designed plan would allow people to purchase private insurance to cover things the government plan doesn't. (Over 90 percent of the people in the French system have supplemental insurance.)
So what's in it for me, the contentedly covered? If the plan is done right, I am left healthy and wealthier. And if I ditch my job -- or my job ditches me -- I can find affordable coverage. That should not be a hard sell to anybody.
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