Ron Wyden's smart health-care plan.

The thinking behind the news.
Feb. 28 2007 4:06 PM

Better Health Through Politics

Ron Wyden's smart plan.

Ron Wyden. Click image to expand.
Sen. Ron Wyden

America's health-care system runs the gamut from capitalism to socialism, stopping at all points between. At the free-market extreme are 10 million people who buy private insurance without any government help and 48 million people with no insurance at all. At the collectivized end are 5 million military veterans who see government doctors in government hospitals, 32 million retirees covered directly by the federal government under Medicare, and 37 million insured by Medicaid. In the middle are the majority, 153 million workers and their families, who get government-subsidized private insurance through their employers

Jacob  Weisberg Jacob Weisberg

Jacob Weisberg is chairman and editor-in-chief of The Slate Group and author of The Bush Tragedy. Follow him on Twitter.

A growing consensus recognizes this patchwork as economically disadvantageous and morally intolerable. Viewed as a whole, the American system is inefficient, expensive, and possibly unsustainable, consuming 16 percent of GDP and growing at a rate of 6.4 percent a year. European countries manage to provide universal, high-quality care for half as much per capita. Employer-based coverage is a drag on the economy, tethering workers to jobs they would otherwise leave and harming the competitiveness of American manufacturing by adding to the cost of goods. Health-care spending is a budget-wrecker at every level of government. And for all we spend, 16 percent of the population, including 8 million children, must make do at the system's charitable margins.

Advertisement

But if the status quo is untenable, the Euro alternative remains an impossible sell. Americans place a high premium on personal liberty and individual choice in all matters. A single-payer system, in which government insures everyone directly, diminishes consumer freedom for the sake of greater equity and efficiency. Many resist making that trade-off, even where it would serve their interests. As recently as 2000, Oregon, which is either the most—or the second-most, after Vermont—progressive-minded state in the country, defeated a single-payer initiative by a margin of 4-to-1.

The action at the moment is all in the big space between the status quo and single-payer. President Bush started the conversation in his January State of the Union address, in which he proposed capping the tax deductibility of employer-provided plans and creating a new tax deduction for individuals. By turning the health-care tax deduction into a kind of voucher, Bush would discipline spending and allow more individuals to afford insurance. His proposal didn't deserve the scorn heaped on it by leading Democrats. A paper from the liberal Tax Policy Center calls the president's proposal "in some respects … innovative and a step in the right direction." But Bush is thinking too small. His plan risks undermining the current employer-based system without replacing it, and fails to grapple in a serious way with the problem of the uninsured.

John Edwards recently became the only presidential candidate to get specific on the subject, when he laid out a plan bolder than Bush's that would build on the employer-based system. Edwards would require companies that don't insure their workers to pay into a fund for the uninsured. Following the trend in Massachusetts and California, he would add an individual mandate, a requirement that anyone not covered at work buy insurance in a regulated market. The chief advantages of the Edwards plan are that it achieves universal coverage without disrupting the way most Americans now receive health care, and that it's straightforward about raising taxes to pay for extending coverage to the uninsured. Its chief disadvantages are that it would do little to control costs and that it fails to break the anachronistic connection between employers and insurance.

TODAY IN SLATE

Politics

The Democrats’ War at Home

How can the president’s party defend itself from the president’s foreign policy blunders?

An Iranian Woman Was Sentenced to Death for Killing Her Alleged Rapist. Can Activists Save Her?

Piper Kerman on Why She Dressed Like a Hitchcock Heroine for Her Prison Sentencing

Windows 8 Was So Bad That Microsoft Will Skip Straight to Windows 10

We Need to Talk: A Terrible Name for a Good Women’s Sports Show

Politics

Cringing. Ducking. Mumbling.

How GOP candidates react whenever someone brings up reproductive rights or gay marriage.

Music

How Even an Old Hipster Can Age Gracefully

On their new albums, Leonard Cohen, Robert Plant, and Loudon Wainwright III show three ways.

The U.S. Has a New Problem in Syria: The Moderate Rebels Feel Like We’ve Betrayed Them

Homeland Is Good Again! For Now, at Least.

  News & Politics
The World
Oct. 1 2014 12:20 PM Don’t Expect Hong Kong’s Protests to Spread to the Mainland
  Business
Moneybox
Oct. 1 2014 2:16 PM Wall Street Tackles Chat Services, Shies Away From Diversity Issues 
  Life
The Eye
Oct. 1 2014 1:04 PM An Architectural Crusade Against the Tyranny of Straight Lines
  Double X
The XX Factor
Oct. 1 2014 2:08 PM We Need to Talk: Terrible Name, Good Show
  Slate Plus
Political Gabfest
Oct. 1 2014 1:53 PM Slate Superfest East How to get your tickets before anyone else.
  Arts
Brow Beat
Oct. 1 2014 3:02 PM The Best Show of the Summer Is Getting a Second Season
  Technology
Future Tense
Oct. 1 2014 3:01 PM Netizen Report: Hong Kong Protests Trigger Surveillance and Social Media Censorship
  Health & Science
Science
Oct. 1 2014 2:36 PM Climate Science Is Settled Enough The Wall Street Journal’s fresh face of climate inaction.
  Sports
Sports Nut
Sept. 30 2014 5:54 PM Goodbye, Tough Guy It’s time for Michigan to fire its toughness-obsessed coach, Brady Hoke.