Wednesday, March 12, 2008

Universal coverage - Short Take on Universal Coverage

What – Universal coverage for all.

Why - Because it’s hot issue, after the economy, in this year’s presidential campaign. Come November, Democrats may regret they carried on about universal coverage. Nine of ten Americans will be covered, and calls for individual mandates and higher taxes to enforce mandates may not sound so good. Besides, universal coverage will not snuff out rampant inefficiencies and perverse incentives that lead to skyrocketing costs.

When – When will reform occur? Not this year or next, maybe not even in the next decade. After all, Americans been debating reform since 1912. Health reform is evolutionary.. It will not occur in one swoop in response to pleading from a single political party. When will absolute universal coverage occur? Maybe never. Millions of young people will continue choose to spend their money elsewhere and will evade paying individual mandates; and perhaps 10 million eligible for Medicaid, will not show up or enroll.

How – Reform and coverage may take a world depression, a world war, or an unprecedented natural disaster.. Americans may not be ready for a universally mandated system requiring every citizen to pay individually or face fines, garnished wages, tracking down non-payers, and higher federal taxes.

Where - Most likely in D.C . since state experiments have failed or are beset by unexpected costs. Imposing top-down command and control reform on the present system will be expensive. Universal mandates may be alien to our individualistic, government-distrusting culture. Most likely reform will be spotty and will be accompanied by market innovations offering wider choice and quicker access.

Who - A charismatic bullet-proof president with a veto-proof, lobby-proof Congress, a promise of no tax raises, no goring of special interest oxen, and cooperation from physicians to deliver the goods.

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