Wednesday, March 08, 2006

Why not universal coverage?

The consensus on the blogs is that universal public health care (aka single-payer, Medicare for all, or what have you) is the only solution to the health care crisis. What we have to do, say our friends on the left, is eliminate the connection between health care and employment. Yet here we are at the WFP, proposing a Fair Share plan that reinforces employer responsibility for health care. What gives? Do we think Kevin Drum, Ezra Klein, Matthew Yglesias and the rest of them are all wrong?

Not at all.

There is no question that in the long run, the only way to control healthcare costs and guarantee universal coverage is through a greatly expanded role for the public sector. The WFP has been on record in support of universal public health insurance since our founding, and we still are.

But, we think Fair Share is the right proposal for New York State, for this year. Here’s why:

There is a healthcare crisis now. Progressives – including us! – have been pushing for single-payer for years. Realistically, it will be years more before we win. Meanwhile, 3 million New Yorkers are going without needed healthcare because they lack insurance. We believe that – with a lot of work and a little luck – a broad employer mandate can pass this year. If that extends health benefits to half a million uninsured New Yorkers, that's a big step, even if it doesn't solve the larger healthcare problem.

We need to defend existing coverage, until we win real reform. Over the past 15 years, New York has greatly expanded public health programs, yet the number of uninsured has hardly budged. As fast as we add people to public programs like Medicaid and Child Health Plus, we lose them from employer coverage. Meanwhile, those who do have insurance face skyrocketing contributions and out-of-pocket costs. Fair Share will prevent big businesses from further shifting costs to workers while we move toward real reform.

Fair Share creates a constituency for further reform. Our current crazy-quilt system rewards businesses that are able to shift health costs to their workers, other businesses and the public. As long as these businesses can freeload, they will be implacable opponents of reform. but once they are paying their fair share, they will have the same interest in a rational health care system as the rest of us.

We need to prove that healthcare is a winning political issue. As Mark Schmitt says, "universal health care is universally supported by people who don’t have to win elections and universally feared by people who do." If we can mount a winning campaign on Fair Share, it will make it much easier to convince politicians to take a chance on broader reform.

Fair Share is an idea whose time has come. All across the country, people are excited about the idea of requiring employers to pay more for healthcare. 35 states are considering some form of fair share legislation. Labor wants to make it harder for low-wage businesses to undercut union employers. Living-wage advocates are looking for the next step beyond regulating wages. Anti-Wal-Mart campaigners are looking for a winning issue to challenge the big-box goliaths. The media is waking up to the social costs of the low-road model. Fair Share taps into this energy in a way that, at the moment, single-payer does not.

In the long run, we need to fight for universal healthcare. And the WFP is going to do just that. But we think the immediate crisis is too pressing – and the immediate opportunity too promising – to pass up the chance to pass the Fair Share bill this year. Yes, our employer-based healthcare system is in need of major surgery. But first let’s stop the bleeding.

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