We will be reading and hearing a great deal about Universal Health Care in the next two years. The Liberal impulse of compassion will tend to promote plans to cover all of the uninsured, with the argument that a country as wealthy as the United States should be ashamed to have so many of its poor without coverage. The more Conservative impulse will be to structure plans, such as President Bush's recent suggestion, in such a way as to minimize the intrusion of the government bureaucracy and preserve aspects of the private system of health care that has worked fairly well but is now being stressed by the combination of the high cost of modern health care and the increasing demands on the system.
Robert Samuelson has an article at Real Clear Politics today in which he addresses some of the issues involved. In Hiding Health Care's Costs, he describes the sleight of hand that has distorted Medical care for a generation:
For decades, Americans have treated health care as if it exists in a separate economic and political world: When people need care, they should get it; costs should remain out of sight. About 60 percent of Americans receive insurance through their employers; to most workers, the full costs are unknown. The 65-and-older population and many poor people receive government insurance. Except for modest Medicare premiums and payroll taxes, costs are largely buried in federal and state budgets.
Samuelson focuses on the costs of health care and the manner in which our current approaches tend to disguise the actual cost of such care:
I don't intend to examine -- at least now -- all the new proposals. Some would do better at some goals (say, protecting the poor) than at others (say, controlling costs). But the Bush proposal does have one huge virtue: It exposes health-care costs to the broad public. By not taxing employer-paid insurance, the government now provides a huge invisible subsidy to workers. Bush wouldn't end the subsidy, but by modifying it with specific deductions for insurance ($15,000 for families, $7,500 for singles), he would force most workers to see the costs. By contrast, some other proposals disguise their costs. Schwarzenegger's plan shifts costs to the federal government, doctors and hospitals. It's clever, but it perpetuates the illusion that health care is cheap.
Within his description lies the root of the problem with our health care system. In point of fact, in America we already have Universal Health Care. The problem is that we cannot afford to offer all the health care everyone desires to everyone who desires it. In other words, we are faced with the problem that every modern state faces: how do we manage access to a limited resource that so many people believe is a "right"?