A NEW ADMINISTRATION in Washington always brings with it speculation about what policy changes will come to our society, and near the top of everyone’s list of priorities lies health care reform. Although the past century is dotted with unsuccessful attempts to pass comprehensive reform legislation, soaring costs and a growing number of uninsured Americans could provide enough motivation for something to be done. Ezekiel Emanuel, a breast oncologist and Head of the Department of Bioethics at the National Institutes of Health Clinical Center, brought his proposal (which is detailed in the recently published article “Healthcare, Guaranteed”) to the University’s Medical Center Hour Nov. 19. Emanuel’s plan sheds much-needed light on the many bugs in our national healthcare system, but his solution creates new problems both financially and ethically.
Emanuel’s Guaranteed Healthcare Access Plan eliminates two fundamental flaws in American healthcare. First, it guarantees healthcare coverage to all Americans; factors like age, race, or the presence of a preexisting condition cannot prevent one from being denied the benefits of insurance. Second, it removes the responsibility of providing coverage from employers. The current system makes it difficult to change jobs or start a business, denies workers a choice among healthcare plans, and can force businesses to decide between profits and adequate coverage for their employees. Emanuel’s proposal would give every citizen a certificate to choose his or her own health care plan.
However, the Guaranteed Healthcare Access Plan fails to make use of the cost control method that is both simplest to implement and most beneficial to public health: preventive medicine. By providing coverage at no direct cost, Emanuel’s plan gives no incentives for people to make sacrifices for their health. Under the plan, insurance companies would be obligated to provide a “standard set of benefits” regardless of an individual’s health, and, according to Healthcare, Guaranteed, the government “will pay health insurance companies and plans more money per patient on average when the organizations enroll older, sicker patients, and less money when they enroll young, healthy people.” Everyone should have the same access to healthcare, but individuals should be rewarded for practicing healthy behavior like refraining from smoking, choosing a healthy diet, and getting regular check-ups and screens. Such actions are better for an individual’s health and are a preferable alternative to the high costs of dealing with preventable medical issues associated with — for example — certain forms of obesity and cancer.
Compensation for healthy behavior should be factored into Emanuel’s method of financing his plan, which overlooks the many different medical needs of the American society. The proposed value-added tax on consumer goods would mean that the amount one pays into the system is determined by the number of non-health related products they purchase rather than the fraction of health care resources they extract from the system. Also, the tax would be the sole means of financing the healthcare system. If the demand for necessary healthcare services grew, the quality or amount of coverage provided would decline until the tax rate was increased.
Emanuel claims that his plan would help the economy by allowing businesses to avoid healthcare costs, devote money to core purposes, and pay their employees more. Healthcare Guaranteed contends that “employees will demand and receive higher wages since they will no longer be getting healthcare benefits from their employers,” but this argument raises the question of whether those savings will actually trickle down to the workers or not. The fact that companies will lose the tax exemption for providing a healthcare plan to employees suggests the latter.
The assertion that the plan will produce more competition among healthcare providers also needs to be supported. Emanuel proposes that Americans would have a choice between insurance carriers through Regional Health Boards. However, “Healthcare, Guaranteed” states that “the number of health plans and insurance companies nationwide will be substantially reduced,” thus restricting choice. The pluralistic structure of our society would probably cause the remaining companies to cater to different niche markets, diminishing choice even further. Emanuel also needs to specify how insurance companies would be paid under his proposal, since the industry would no longer be privately owned. If carriers were to be paid based on a standard, this could inhibit the need for competition or encourage insurance companies to focus on meeting these standards rather than providing the best coverage.
Emanuel’s proposal draws attention to major problems in our healthcare system — including the millions of uninsured Americans and the ever-expanding chunk of state and federal budgets that is being eaten up by healthcare program costs. But these problems should be tackled on a smaller scale; one all-inclusive reform plan cannot fix the healthcare system of such a diverse society with a wide range of medical needs.
Mitch Ross’s column appears Thursdays in The Cavalier Daily. He can be reached at m.ross@cavalierdaily.com
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