'Long Time Coming': Are We on the Brink of Universal Health Care Coverage?

Abstract

The financial meltdown and bailout of September-October 2008 have shocked everyone. The headlines tell it all: Wall Street, R. I. P. (Creswell & White, 2008), Retirement accounts have lost $2 trillion so (J. H. Davis, 2008), Greenspan's free-market faith shaken (Irwin & Paley, 2008). Bernstein (2008), a well-known investment adviser and historian, described the bailout as an earth-shaking blow to the most basic principle of our economic namely, faith in individual decision-making in free markets (p. 8). Despite the severity of this crisis, we should not allow it to deflect attention from the ongoing meltdown of our health care system (http://medicine.plosjournals.org/perlserv/?request=getdocument &doi=10.1371/journal.pmed.0050208). In recent months, several studies and reports have examined the dimensions of this crisis: * The Commonwealth Fund Commission on a High Performance gave the U.S. health care system a score of 65 out of 100 on 37 core indicators of performance (http://www.commonwealthfund.org/publications/ publications_show.htm?doc_id=692682). * In 2007, 45 million people were without health insurance. Although this represented a decline from 2006, when 46.5 million people had no coverage, the improvement was due to an increase in through public programs (Fronstin, 2008). The uninsured population is likely to increase in 2008. * Twenty-five million people have inadequate coverage, which ensures neither access to care nor financial protection (K. Davis, 2008). Low-income people have particular difficulty finding adequate coverage. * Medical debt has become a serious problem, with a third of the population reporting their families have had difficulty paying medical bills (http://www.kff.org/newsroom/ posr102108nr.cfm). One study suggests that health care issues, including sickness and medical debt, may play a central role in home foreclosures (http://works.bepress.com/cgi/ viewcontent.cgi?article=1001&context= christopher_robertson). * Between 1999 and 2007, while health insurance premiums grew by 114 percent, earnings grew by just 27 percent (http://www.rwjf. org/pr/product.jsp?id=35368). * Women buying in the nongroup health insurance market often pay far more than men do for identical coverage (Pear, 2008). These grim realities are not new to social workers or readers of Health & Social Work. What is new is their context. Whatever we may think of the bailout, it has undermined two central ideological objections to universal health care (UHC).The first is that we need to limit the role of government. It is difficult to oppose an expanded role for government when perhaps the most conservative administration since the 1920s not only partially nationalized our banking system, but also gave bankers no choice in the matter. In addition, the Bush administration is developing a plan to assist homeowners facing foreclosure (Bajaj, 2008). If we can take radical steps like these, why not regulate our health care system and extend to people without insurance? The second objection is that government provision of health care promotes what economists call moral hazard (Nyman, 2004). Moral hazard occurs when insurance insulates or protects individuals from the consequences of their actions (Gladwell, 2005). In terms of health care, if individuals know that the government or an insurance company will pay their bills, they will be more willing to engage in reckless behavior than they would if the burden of cost fell to them. Nyman (cited in Gladwell, 2005) argued that concern about moral hazard explains 'the general lack of enthusiasm by U.S. health economists for the expansion of health insurance coverage.' However, the financial bailout has made a mockery of concern about moral hazard. Once the federal government declares, 'Thou shalt not fail,' there are no limits to how far future risk-takers will go (Bernstein, 2008, p. …