157349 Universal health insurance: The Massachusetts and California indvidual mandate model

Tuesday, November 6, 2007: 2:35 PM

Susan Adler Channick, JD, MPH , Faculty, California Western School of Law, San Diego, CA
     
Since the early 1990s, there has been relatively little momentum for health care reform. Notwithstanding data that demonstrate the correlation between health insurance and health status, the number of uninsured Americans continues to grow each year. The bulk of health care dollars, currently a staggering $2 trillion, is spent on treatment with large amounts spent on untreated chronic disease as a result of lack of access to care.

Recently, proposals to broaden the scope of health insurance coverage are rife. States like Massachusetts and California have already begun the legislative and administrative journey toward universal coverage. In his State of the Union address, President Bush announced a federal plan to increase health insurance coverage by spreading the tax subsidy currently enjoyed by employers and employees to all individuals through federal tax deductions.

These plans are described as universal insurance but they are not the traditional “government as single-payer” model. They require all residents to have health insurance and envision that this individual mandate could be satisfied in a number of different ways. The language – universal health insurance – is the same but the model – individual mandate – is quite different. It may be that the individual mandate model to achieve universal coverage is more plausible in the United States than the single-payer model but the similar vocabulary is at least distracting and at worst misleading. If universal health care is going to be our predominant health care discussion, we should be speaking the same language for the conversation to be meaningful.

Learning Objectives:
The primary learning objective of this presentation is to distinguish between the traditional meaning of universal health care as single-payer and what appears to be the more recent usage of the term – individual mandate. While universal health insurance literally means a system whereby the entire population has health insurance that guarantees some level of access to health care, traditionally the government has been envisioned as the only payer. The individual mandate model for universal health insurance requires all individuals to have health insurance which can be satisfied in a number of different ways – through employment, through public insurance programs such as Medicare and Medicaid, and through individual policies which may be partially subsidized by employers, providers, insurers, and governments. The goal is to bring all of the constituents into the process of providing and paying for health insurance. The single-payer model of universal health insurance has been part of the health insurance vocabulary for such a long time that it has become almost a term of art. Since the individual mandate model is also universal health insurance, people are likely to be confused by these two different models that seek to achieve the same goal. In order to ensure that the political dialogue of universal coverage is meaningful, the public will require some reeducation. I propose to provide some clarification by deconstructing the individual mandate model and comparing it to the traditional single-payer model to distinguish how the two different models operate. I also plan to critically evaluate the differences between the two models and their respective political plausibility. It is one thing to aspire to universal health insurance as a policy; it is another to muster the political will to make it happen.

Keywords: Access to Health Care, Health Care Politics

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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