Health Care Questions

[Peter Suderman]

Elizabeth Edwards has some questions about John McCain's health-care policy. I certainly think she frames her question in a way that ensures maximum political potency. But I have some quibbles and questions.

No plan, even with a mandate, really provides for truly universal coverage; Massachusetts hasn't managed to sign up everyone with its supposedly universal plan, and even in France, there's a very small percentage who are left uncovered. But granted, an Edwards-Clinton style mandate would guarantee coverage to more people.

She also asks if competition will really lower costs considering that we have competition today and costs are rising. Well, yes; costs are rising today, but that's in part because people weren't happy with efforts made by insurers to reduce costs. Costs briefly held steady in the mid 90s as a result of managed care, but there was considerable frustration with the limitations managed care put on patients. No one likes rising costs, but no one likes being forced into narrow care schemes either. Giving insurers more flexibility to design affordable plans, rather than piling on the state-level requirements, probably would push costs down, and allow those seeking coverage more options in what they want to pay for and what they don't. You can portray this as a "race to the bottom," as she does, but it also allows for more efficient insurance that's not weighed down by expensive, and often unnecessary provisions.

And while no insurer would be required to cover either Mrs. Edwards or McCain under the McCain scheme, that doesn't necessarily mean that either would be prohibited access to insurance either. Government and employer plans of the sort that both rely on for coverage would still exist. It's not as if McCain would take away anyone's care; he simply wouldn't push additional requirements on insurance companies.

It's easy, of course, to get bogged down in details: The question, in the end, is whether health care is a universal right. When someone falls ill, is it the responsibility of the collective—all the citizens of the nation -- to bear the costs of treatment? Or is it the responsibility of the individual, through whatever financial means, personal connections, or other agreements he or she has made, to arrange for care? And if there is an obligation, how far does it extend? Basic as these questions may be, it's tough to answer other, more specific questions until you have answers on these. A lot of people tend to answer purely pragmatically -- I don't care! I just want to provide better health care to more people -- or at least me -- on a short or medium term basis. That's understandable. But I also think it's that lack of certainty on the underlying principle which has caused a lot of the confusion and systemic problems in the way we currently provide coverage and care.