universal coverage


U.S. Health Care Is Less Private, More ‘Socialist’ Than You Might Think

The extent of the government's role in health care has become a key issue in the Democratic presidential primary. Here, candidates Hillary Clinton and Bernie Sanders are seen in a debate on Jan. 17 in Charleston, S.C. (Mic Smith/AP)

The extent of the government’s role in health care has become a key issue in the Democratic presidential primary. Here, candidates Hillary Clinton and Bernie Sanders are seen in a debate on Jan. 17. (Mic Smith/AP)

By Richard Knox

Readers, a pop quiz:

The proportion of U.S. health care paid by tax funds is (a) less than 30 percent, (b) about half or (c) more than 60 percent.

If you picked “more than 60 percent,” you’re right — but you’re also pretty unusual.

“Many perceive that the U.S. health care financing system is predominantly private, in contrast to the universal tax-funded health care systems in nations such as Canada, France or the United Kingdom,” David Himmelstein and Steffie Woolhandler write in a new analysis of U.S. health spending in the American Journal of Public Health.

They find that 64.3 percent of U.S. health expenditures are government-financed. And they project the tax-supported proportion will rise to 67.1 percent over the coming decade as the baby boom generation ages and retires — nearly as high as Canada’s 70 percent.

“We are actually paying for a national health program, we’re just not getting it,” Woolhandler says.

tax dollars for U.S. health spending

Now, Himmelstein and Woolhandler have an agenda. For decades, they’ve been perhaps the leading researchers promoting the kind of single-payer health system that Socialist and Democratic presidential candidate Bernie Sanders has put on the debate agenda. One recent poll suggests more than half of Americans (and 30 percent of Republicans) support the idea.

But even if you disagree with the Himmelstein-Woolhandler ideology, their research is generally regarded as sound, and their method is straightforward.

They added up what federal and state governments spend on health through Medicare, Medicaid, the Veterans Health Administration, government employees’ health care premiums, tax subsidies and other programs. They argue that accounting by government agencies (the Center for Medicare and Medicaid) undercounts the real tax burden because it leaves out major pieces of the pie — such as government employees’ care ($156 billion a year) and tax subsidies for private, employer-sponsored coverage (nearly $300 billion).

And whatever you think about Medicare-for-all, it’s a good idea to see the present U.S. health care system for what it is — an increasingly government-funded financing scheme. Continue reading

Chef Chang: Absorb Obamacare Costs And Do Right By Workers

Chef Joanne Chang


WBUR’s Cognoscenti posts a column today by restaurateur and celebrity chef Joanne Chang that will surely be of wide interest to her food-industry colleagues around the country — and other small business owners as well. She says, in effect, that yes, the federal health reform known as Obamacare will add to your business costs by requiring health insurance for employees, but it is wrong to reduce good employees’ hours in order to avoid getting them covered.

She begins with a question she heard at a recent meeting of restaurant professionals:


“If Obamacare stays in place, will you reduce your staff’s hours so that they are no longer full-time and thus you won’t have to cover them under your health plan?” And her response:

As the only business owner from Massachusetts, where a health care law that closely resembles the president’s Affordable Care Act has been in place for the last five years, I shared my experience (and tried to hide my shock). No, we did not reduce hours — nor did we even consider it. If someone strong is working for you, it seems counterintuitive to have them work less, even if it costs you a bit more.

My business has absorbed the costs associated with the new health mandate in the same way we absorb rising fuel surcharges or higher prices of flour. They cut into our profit, sure, but when I weigh the cost of paying staff to cover for chronically sick employees who don’t see a doctor because they don’t have one, or the pressure of knowing that my 24-year-old barista can’t afford coverage because he only makes $10 an hour, I willingly take the cut to my bottom line.

Read the full post here.

All 100 Million Mexicans Have Health Coverage, While To The North…

(Smooth_O on Wikimedia Commons)

The parallel is unmistakable. Before the reforms that brought in health coverage for all, Mexico had 52 million residents who were not covered. We here in the big rich neighbor to the north have about the same number of people — roughly 48 million in a recent count — who lack health insurance. Mexico has shown over the last decade that it is possible to cover everyone. We — well, you know.

Just out in the medical journal The Lancet is a sweeping look at how Mexico brought in universal coverage, and the health benefits the country reaped, including significant drops in the death rates among babies and children and mothers. A Lancet editorial concludes that Mexico has demonstrated that universal coverage, “as well as being ethically the right thing to do, is the smart thing to do.”

I’m afraid my first question to the Lancet paper’s lead author came out a little plaintive:  Why? Why could Mexico do it, reach universal coverage, while America seemingly can’t? Felicia Knaul is the director of the Harvard Global Equity Initiative and a senior economist for the Mexican Health Foundation. Her reply, by phone from Mexico City:

‘This country chose to believe in the fact that people’s access to health should not be defined by where they work’

“First let me just say, i think the United States is moving forward in the right direction and we just have to keep that forward movement going, in all sorts of senses. I can tell you why Mexico did it; I can’t tell you why the United States didn’t until now.

This country chose to believe in the fact that people’s access to health care should not be defined by where they work but rather by their need for health care. Number two, in addition to this being a right, a social entitlement, it was good for human development, for social development, for economic development, to make sure people were not going bankrupt and suffering impoverishment and catastrophe from trying to figure out how to manage the cost of health care.”

Was it, I asked, a convergence of historical forces? Continue reading