In the comments to Brian Klepper’s piece yesterday, troublemaker commenter JD asks the following
Matt, I don’t know if you can do polls on this site, but I’d be interested to see what the readers here would guess as the date universal healthcare legislation passes. My own guess is that SCHIP expansion happens in 2009 (if not sooner), and effectively universal coverage is passed in 2011, effective in 2012. And my guess is that it is more like the Massachusetts model, actually, than Medicare-for-all. Idle wonkery, to be sure, but enjoyable idle wonkery.
I can’t easily put up a poll without pulling John off some real work, but you can all give your best guesses below. How about these three questions.
1) When will SCHIP pass?
2) When will comprehensive health care reform pass the Congress and get signed by the President?
3) When will we get to what reasonable people would agree was 100% universal coverage?
Have fun!
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1. In 2008
2 and 3. Sometime around 2018-19 at the earliest. We’re going to have to wait until things get much, much worse before the US gov’t can act.
1 is an easier political sell than 2 or 3 and a lot cheaper. I am much more optimistic it will happen sooner.
To steal a thought from Arnold Milstein, Americans will only have 100% universal coverage when they go kicking and screaming to the polls because of bankruptcy issues associated with medical costs.
The big issue isn’t going to be the uninsured which is consistently overrated as a factor when discussing healthcare reform. The uninsured population is primarily made of people who are either in low income levels, poorly educated, or young people. None of these groups vote in large numbers and even in most Democratic wards aren’t a big factor unless it is a swing state in a presidental election year (e.g., Cleveland in Ohio or Miami in Florida).
The real driver of health care reform will be Americans who have health insurance coverage yet are forced to take out high-interest loans and max out their credit cards to pay for medical services. You are just beginning to see this trend as deductibles increase and Americans have larger hospital stay tabs due to coinsurance rates.
1. I would be shocked if SCHIP is allowed expire, so I expect to see some sort of action when Congress is back in session. I highly doubt we will see expansions until after the 2008 elections though.
2. Comprehensive health care reform is a long, long way out. It will come much later than patchwork universal coverage. 2020-ish.
3. 2011, if a Dem wins.
1) When will SCHIP pass? Fall 2008
2) When will comprehensive health care reform pass the Congress and get signed by the President?
By 2012 if we elect a Dem in 2008 if not 2020 at the earliest.
3) When will we get to what reasonable people would agree was 100% universal coverage?
Not in my lifetime–I’m 55, self employed and uninsured. First,”reasonable” people have to agree that healthcare is a public service and not a private good. We’ve reached a tipping point but not the meltdown point. America’s middle class still believe being uninsured only happens to those other folks, you know those poor people.
Remember Medicare passed only because President Lyndon Johnson knew where enough bodies were buried in Congress to arm twist its passage. Opponents added Medicaid for the poor it hopes of defeating Medicare. I don’t see any leader with Johnson political skill on the horizon.
1: After 2008
2: When < 50% of working people get decent coverage
as a perq of employment. Could be never.
3: When < 50% of people get decent coverage
somehow. Probably never.
#1 – 2008 if Democrats agree to cap eligibility at 300% of FPL; otherwise, 2009.
#2 – 2010
#3 – 2011
With respect to #2 and #3, it is important to note that the history of major program reforms in the U.S. is that they need to be bipartisan. In the post World War II era, just about any Senate Minority Whip will tell you that it is fairly easy to get 41 votes to block legislation via the filibuster. Thus, as a practical matter, 60 votes are needed to push major and controversial legislation through the Senate. The risk for Democrats, assuming they win the presidency and maintain control of both houses of Congress, is that they overreach and wind up with nothing.
In reading about the Japanese system recently, I learned that they have three health insurance pools. One is for retirees, I believe, above the age of 70. This is similar to our Medicare population (age 65 and older plus eligible disabled people). The second is the broad base of employees except for the self-employed. The third is the self-employed and the unemployed.
A similar grouping might work well for us. The Medicare program could remain as it is now. The employed could move to payroll tax financing, vouchers, an insurance exchange, and risk adjustment payments for insurers. The self-employed and unemployed funding mechanism could be a mix of payroll taxes (for the self-employed) and general revenue, perhaps paid for by a dedicated value added tax. A payroll tax, if it applied to the same wage base as Social Security taxes are now, would probably have to be at least 15%-16% (combined employer and employee share) to cover the cost. That, when added to the current 15.3% FICA tax for Social Security and Medicare, would drive the total payroll tax to 30%-31%. This is not unusual. I learned on a recent trip to Europe that the social insurance payroll tax in Estonia is 33% (of which 20 percentage points is for healthcare and all nominally paid by the employer) and it’s 36% in Russia. I believe it is also 30% or more in the Nordic countries. I’m not sure about the rest of Western Europe.
This is a key aspect of reform that the middle class needs to understand. There is nowhere near enough revenue to be gained from significantly raising taxes on high income people to finance universal health insurance. As I’ve said repeatedly before, the broad middle class will have to pay to insure the broad middle class.
OK, I’ll bite.
1. don’t know, probably soon.
2,3. Must go together so should be same date. I am a pessimist, say 2015 or later. This will be a looonngg fight.