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Think againThe case for 'Fair share health care'By
TIM NESBITT My June 20 column, in which I advocated a minimum-wage-style law to
require employers to provide health care for their workers, has renewed
the debate over strategies for health care reform. It’s an important
debate that I hope will enable us to reach consensus on a proposal for
the 2006 elections.
Oregon Education Association member Dan Welton’s letter
to the editor of this newspaper (“OEA member favors universal
health insurance,” Aug. 19, 2005) made a case for single-payer health
care that highlights a central issue in the debate between those who want
to repair our employment-based health care system and those who want to
scrap it for a taxpayer-funded system. That issue is: Who pays?
It’s true that our employment-based system is fraught with problems,
as I acknowledged in my column. But combining small employer groups into
large groups, as union trust funds do, can solve at least some of those
problems. Follow that path, and you eventually arrive at a “single-
purchaser” system in which many separately-funded employer groups
combine their purchasing power to negotiate payments to providers and
oversee the delivery of services in ways that can reduce costs and improve
outcomes.
But a single-purchaser system doesn’t require a single payer. How
we purchase services and how we pay for them are two different issues.
And, when it comes to paying for health care, we are dealing with an issue
that affects the financial well-being of workers in the U.S. as much as
their physical well-being.
For all its problems, our employment-based health care system has, until
recently, managed to provide affordable health care to most working families.
Most union members pay only a fraction of the premium costs of their health
insurance. And even workers without unions, whose benefits lag behind
those of their union counterparts, usually pay less than half of their
total medical costs if they have insurance. Employers pay the bulk of
those costs, thanks to the principle that our union movement helped to
establish after World War II — that when you work for a living,
you earn your health care.
What would we get if we abandoned that principle?
We could say that every citizen or taxpayer is entitled to health care
from the federal or state government and shift the cost of that care to
our tax system. The trouble is that the taxpayers are us, mostly. Businesses
pay only a small share of total tax revenues collected at the federal
and state level. In Oregon, businesses pay about 15 percent of the state’s
general fund revenues, even when you count the personal income taxes paid
by small business owners on the business side of the ledger.
Imagine if your employer proposed to change the cost-sharing formula for
your health insurance so that you paid 85 percent of all premiums and
charges. You’d prepare for a strike – or prepare to trim your
family budget by about $700 per month.
Yes, our health care system is in crisis. For one of every six Oregonians,
the crisis is that they have no health insurance. But, for the other five,
it’s a crisis of cost. Most Oregonians with health insurance want
to keep the insurance they have. They hope their employers will pay more
as costs rise, but they appear willing to continue to pay more from their
own paychecks as well. This is why the health care crisis is affecting
more than the health of working people in America; it’s squeezing
their family budgets and their standard of living.
We have to control health care costs if we want working Americans to start
getting real raises again. And, since a big component (as much as 10 percent)
of health insurance premiums and charges are the costs shifted from the
uninsured to the insured, we have a two-fold opportunity to address access
and affordability with a single reform: We can extend coverage to the
uninsured and reduce costs for the insured by requiring all employers
to pay their fair share for health care.
Single-payer advocates are focused on the universal coverage that a government
system can guarantee. That’s the strongest argument for a single-payer
system. But we can build universal coverage on a foundation of employer-sponsored
health care, with a role for government in covering the elderly and disabled,
the unemployed and, perhaps, children as well.
The foundation of employer support for health care would be dismantled
if we were to adopt a system supported in full by our current tax structure.
Working families would pay a lot more; their employers would pay a lot
less. That’s why I like the idea of forcing all employers to support
our health care system, before we renegotiate the payment shares for that
system.
But there are more pragmatic reasons for moving forward with an employer
mandate. A single-payer system will require new taxes and government-sponsored
health care. I have no objections to new taxes, if they’re fair.
And I’m ready to argue that a government-run program can be both
efficient and cost-effective, with Social Security as a prime example.
But a large majority of the public, aided and abetted by a massive media
campaign by those who have a vested interest in the current system, will
almost certainly react negatively to both of these elements. And I found
in the campaign for the single-payer plan in 2002, that voters like my
mother (with no prompting from me) got very nervous at the prospect of
having to trade the health care plans they have now for a government plan,
even one that promised better benefits. For these reasons, I don’t
think a single-payer proposal can succeed in Oregon, even though our health
care crisis is worse than ever.
So why not start with a proposal we can win — and one that we know
can reduce costs and expand coverage for working Oregonians? Tim Nesbitt is president of the Oregon AFL-CIO. For more information, check out the Oregon AFL-CIO online at oraflcio.unions-america.com
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