AUDREY R. CHAPMAN
Health Care Reform
The United States is on the threshold of national health care reform. For the sixth time in this century, policymakers are considering major changes in the manner in which health care is financed. This may be the final opportunity to end the national disgrace of being the only major industrialized country that does not recognize the right of its citizens and residents to basic health care. If the health care system is not made more equitable now, it is unlikely to become more so in the future. More than any other policy initiative, failure to achieve meaningful health care reform will confirm the sense that it is not possible for the government to resolve national problems. Moreover, nothing less than the national covenant between the government and its citizens is at stake. Very likely, the manner in which the reform addresses the needs of the nearly 39 million Americans who currently lack health care insurance will also play a major role defining what kind of country this will be in the twenty-first century.
Of the various health care reform plans under consideration by Congress, the "single-payer" system introduced by Rep. Jim McDermott (D-WA) and Sen Paul Wellstone (D-MN), is the most consistent with human rights criteria. The single-payer plan would establish a health care system similar to Canada's in which all citizens and legal residents would have immediate guaranteed access to a comprehensive standard benefits package. As noted in the previous chapter, a single-payer system would be more capable of achieving and sustaining universality, assuring social equity, and holding down health costs than managed competition. Under the proposed single-payer plan, a national health security board would set pricing standards for covered services but delivery would basically be unchanged. The government would also establish annual national health budgets to control costs. To finance health care, substantial payroll taxes would be imposed on employers, replacing the cost of insurance that most employers now pay. Individuals would pay nothing.