Introducing a federal HMO for health care

Whiskey and Rye
    By John Schochet

In this great capitalist democracy, we have a socialist government. And, amazingly, the Republicans haven't tried to change that. By socialist, I mean that the people pay taxes to the government, and the government equitably provides a service or infrastructure to the people at no cost. We have roads. Schools. National defense. Police. FDIC Insurance. Air safety. You get the idea; these are all examples of the services provided by a socialist federal or state government.

Why does our government have socialist elements? Evidently it decided that some programs are more efficient if funded by taxpayer dollars and provided for everyone's free use. After all, it wouldn't be fair if rich people could buy better military protection, air traffic controllers, or freeways than the Average Joe.

What boggles the mind is the sad fact that health care does not fall under this umbrella. It's kind of important, given that quality medical care is the best way to prevent premature death. It's kind of necessary, given that 44.3 million Americans do not have medical insurance under the current system. And it's kind of already being included, given that Uncle Sam already insures people through Medicare, Medicaid, and health insurance programs for government employees. Back in 1994, President Clinton, LAW '73, had a bloated scheme that went down in flames, even with a Democratic Congress. The Democratic Presidential candidates have their own ideas for reforming health care, both of which are better than the current system, but not by much. The Republicans try to act like they care about the uninsured, but deep down inside they know that anyone who can't afford health insurance probably doesn't deserve it anyway.

The best solution is the simplest one. The federal government should run a large HMO of its own, and make all Americans members. Funded through income taxes, it would provide everyone with a quality of health care relatively similar to that which most HMO-covered Americans receive today. Europe and Canada have similar systems. Health care was the one element of the welfare state that Margaret Thatcher didn't dare touch during her Reaganization tantrum of the '80s.

With a federal government HMO, quality of care would stay the same or improve. People who today have no insurance or are covered through bad government programs—Medicare and Medicaid—would have health care, which would clearly be an improvement. Americans with HMO insurance would get basically the same thing. Those who currently pay more for better health care plans would have the option to continue paying more for better insurance—just as parents can pay for their children to attend private schools, provided that they also pay taxes that support the public school system. I'm sure the government-run program would be stubborn and bureaucratic, but that's exactly what we already have with private-run HMOs. So the current system brings us all the disadvantages of government insurance (red tape, annoying bean counters) without any of the benefits (universal insurance).

The national HMO would cost less. Americans already pay an incredible amount of money for their non-government insurance. Taxes would have to be raised to pay for government insurance, but in exchange we'd no longer have to pay for our current health plans. Also, current government programs such as Medicare and Medicaid would be absorbed into the new, universal program, so that we'd no longer have to fund them. Today, the uninsured are entitled to government-funded emergency medical care, but under the national HMO they'd get less expensive preventive care. Finally, there's the issue of profits. Of all the money we pay to health insurance companies, some of it goes directly into their pockets. The government doesn't need a profit, it just needs to cover costs.

Who benefits from national health insurance? Clearly the 44.3 million uninsured Americans would be better off. The rest of us who are covered—like all Yale students—wouldn't have to worry about constantly-changing plans, or about evil HMOs that are out to cut corners around our health in the name of profit. Taxes would be a bit higher, but we'd never have to pay a premium again, so these factors would cancel each other out.

Can we trust a Big Government program with our health? I trust the government to build the roads I drive on. I trust it to prevent a foreign army from invading. I trusted it to provide me with an education for 12 years. Why shouldn't I trust it with my health care? Because the insurance industry put an ad on TV that said it was a bad idea? We're all smarter than that. There's an easy solution to our health care crisis. It's tested, European, and equitable. More importantly, it costs less and provides equal to better service.

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