Pro-choice Universal Health Care

by The New Republic Staff | January 16, 2007

In its latest edition, USA Today praises all the new proposals for universal health care -- and expresses the hope it will ignite similar action in Washington. That's great. What's not so great is the following line from the editorial, applauding the plans put forth by Governors Mitt Romney and Arnold Schwarzenegger:

Unlike European-style plans, they preserve private insurance, and therefore choice and innovation, with government oversight.
This one of the most persistent myths about universal health care in Europe -- and, by extension, proposals that call for greater government intervention than either Romney or Schwarzenegger have. So let's be clear: It's entirely possible to have even a single-payer health care system, where the government provides health insurance, while reserving a role for private insurance. In France, the government provides basic insurance; people can then purchase private supplemental insurance to cover expenses that the main program does not. In Germany, some (but not all) people can opt out of the public system altogether, and choose private insurance instead. England has private insurance, too; people use it to jump ahead of the system's relatively long queues. (For more on these and other systems, see Ezra Klein's "Health of Nations" series.) Here in the U.S., we also have a system that works along these lines. It's called Medicare. Seniors can buy private supplemental insurance to cover gaps in Medicare's basic coverage. And they can opt out of the public program altogether, enrolling instead in a private insurance option. One other thing worth mentioning: Whatever their design, universal health care systems can allow freer choice than Americans typically get nowadays. France, again, is the clearest example: The French can see any doctor they choose, any time they want. (Whether or not that's an entirely good thing is a topic for another day.) If you're an American and you think you have the same wide-open access, you'd better read the fine print in your insurance manual, the part where it talks about gate-keepers and approved networks of doctors. (Thanks to Don McCanne, senior health policy fellow at Physicians for a National Health Program, for sending along the clip. His own assessment of the latest plans also appears on USA Today's editorial page.) -- Jonathan Cohn

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