Universal Health Care: Now or Later – Redux

In my last article I explained why, as regards a time frame, universal health care is down the street rather than around the corner.  However, Democrats have taken several actions that demonstrate the Party’s commitment to the process.

This past week New York Mayor Bill de Blasio announced a program to guarantee medical care for every resident regardless of ability to pay.  The goal is to encourage people to use one of the city’s 70 public clinics rather than waiting until a health problem gets worse and then going to a public hospital emergency department.  The estimated annual cost for the program is $100 million but the city should save even more by deferring use of acute care hospital services.  This should also increase the city’s share of state revenues that are going to private hospitals even though the city’s eleven public hospitals serve more low income patients.  Funding will also be used to expand enrollment in ACA insurance exchanges.  According to NYC officials, the program will extend health care to an additional 600,000 city residents (out of a total population of 8.6 million) half of which (300,000) are believed to be undocumented workers and their families – a sticking point for Republicans.  The city plans to implement the program in the Bronx this summer and the rest of the city by 2021.[1]

Critics point out that $100 million a year is only $170 per person.  If the majority of people who quality for the program use health services more than once a year, the costs will quickly escalate.  Time will tell whether this is a cost effective program.

De Blasio is not alone in wanting to offer his constituents access to health care.  California Governor Gavin Newsom recently “asked Congress and the White House to empower states to develop “a single-payer health system to achieve universal coverage, contain costs and promote quality and affordability.”[2]  However, like an insurance plan with a small risk pool, if done at the state or city level, costs could be higher because there are fewer people to spread the costs around.  This is not a problem for California with a population of nearly 40 million, but it would be an obstacle for South Dakota with a population of less than one million.  Additionally, there will be winners (those living in states with universal coverage) and losers (those without).  That’s exactly what we have with Medicaid expansion, where states with Republican majorities have refused to opt in.  These include the majority of southern and western states that also happen to rate the lowest in terms of population health.

Another positive step was the reintroduction of HR 676 by Pramila Jayapal (D – WA).  HR 676 was originally proposed by Democratic representative John Conyers in 2003 and was based on expanding Medicare to all Americans, hence Medicare-for all.  However, as I describe in my book, The Case for Universal Health Care, Medicare was designed to meet the health care needs of seniors, not all Americans; for example, the program does not cover pediatric or reproductive services.  Additionally, Medicare does not cover vision, hearing, or dental services; you need to purchase supplemental insurance for that coverage.

The universal health care plan I describe in my book does cover these services and so does the updated version of HR 676.  In fact, in regard to covered services our positions are essentially the same.  Both our plans resort to a variety of sources to fund the program, some the same such as a tax on certain financial transactions.  However, we differ as to the primary source of funding.  HR 676, 2019 depends on a payroll tax whereas I am promoting a sales tax.

HR 676 will not be passed in 2019 and probably not in 2020, but it is a positive indication of the Democratic Party’s commitment to universal coverage.  First, it will serve as a platform for the party, its current members and future candidates, that it can turn to when communicating their vision.  Second, by putting forth a legislative document, it is open for review, comment, and revision; i.e. improvement.  Third, it is serving as a focal point for the 79 members of the Congressional Medicare for All Caucus who will continue to vigorously push for universal health care.  

A Final Comment: So far, I have described different aspects of universal health care.  Ultimately, however, it all hinges on money.  Universal health care for the U.S.A is not feasible unless there is a sustainable source of revenue – one that is viable now and for future generations and one that can withstand ups and downs in the nation’s economy.  After much research, I have concluded that a sales tax, which I refer to as a health care transaction tax, is the most practical approach.  Therefore, beginning with the next article, I will begin to make the case for this form of revenue generation.      


[1] https://www.goodnet.org/articles/new-york-city-will-provide-free-healthcare-for-all-its-residents

[2] https://www.usatoday.com/story/news/nation/2019/01/09/new-york-city-care-comprehensive-health-care-plan-concerns/2522924002/

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