Undernews is the online report of the Progressive Review, edited by Sam Smith, who has covered Washington during all or part of one quarter of America's presidencies and edited alternative journals since 1964. The Review has been on the web since 1995. See main page for full contents

June 1, 2009


Charley James, LA Progressive - The New York Times reported morning that a major split between Senator Ted Kennedy - back on the Hill as he fights brain cancer - and Senator Max Baucus over the shape and form of universal health care. Kennedy, long a proponent of a single-payer system, is teeing up against Baucus who is negotiating with Republicans over keeping all of health care in the hands of private insurers.

Kennedy and Baucus chair competing committees, and each are racing over creating a plan. . .

The Kennedy plan is relatively simple; the emerging Baucus plan sounds as if it is being written by Jackie Mason.

First, you take health plans that are tax free now and you make some of them taxable, but not all of it, and not for everybody. But who? We don't know who! Then, a new tax deduction puts money in the pocket of the people who we don't know who they are so they can take it out again and buy what they had for free in the first place. Next, the money the states use to pay for medical care for people who don't have health insurance could be used to pay for people who don't have health insurance which means they can't get good health care. But we don't know who they are, either. Well, maybe we know, but we're not sure, so we won't say. Then, three million people who don't have any health insurance will have money from the tax deduction they didn't want, to buy health insurance on their own if they have enough income to take advantage of a $15,000 deduction and can actually can buy a policy that provides coverage. There might be six people in America who can do this. So we're taking money from here, and moving it over there, and then back to here, which where it was in the first place and now let's have some tuna because I'm exhausted. . .

But there is a simple step forward towards universal health care and the basis for it already exists: The insurance plan that covers employees of the federal government, from President Obama to the lowliest entry-level file clerk at the Department of Agriculture.

The plan could start tomorrow, with few studies and almost no increase in cost or federal bureaucracy.

The first step would insure everyone under age 18 through the fed's program.

Every uninsured child would receive immediate coverage. Children covered by a parent's plan would be lifted out of the policy at the anniversary date of their employer's policy and put in the federal insurance pool. Actuaries will love this because healthy, middle class, suburban kids don't get sick as often or as seriously as children of the working poor and underclass from inner cities. So, the insurance risk gets spread across an enormous number of youngsters, lowering the cost for everyone. . .

The cost would be paid by employers, as they do now. Instead of paying a premium to an insurance company on behalf of an employee, the company would pay the same amount to the federal insurance pool. Payroll costs would remain constant and might actually decline a bit: The federal "risk pool,"� or number of people insured, would swell, spreading the actuarial risk of the coverage over millions more people. Premiums for the under-18 crowd would decline as a result, most likely eliminating the need for a worker's contribution to the plan.

At the same time, state Medicaid and SCHIP money spent for covering uninsured kids could be diverted to other medical needs: Providing better treatment for uninsured adults, improving facilities at hospitals and clinics, increasing staff salaries; the list is as endless as the array of needs.

Once children are covered through the fed plan, coverage could be expanded to all currently uninsured adults.

Covering children federally would account for an estimated 15 to 20 million of the uninsured 47 million. Let's be conservative and assume that there would still be 32 million uninsured adults not covered.

The cost of insuring the currently uninsured would be carried by spreading the risk among all adults. No doubt some number of the uninsured cannot get insurance because of poor health. But many of the uninsured will be healthy, small business owners and employees "“ the very people politicians love to applaud "“ so the risk between healthy and unhealthy will be balanced. Small business owners would either divert their current insurance premiums to the federal pool or contribute through a payroll tax reduction made possible through tax credits.

Finally, the fed plan would replace private, employer-sponsored plans. As with dependent children, employers would pay premiums to the federal plan rather than to an insurance company.


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