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Making Universal Health Care Work

Far and away the biggest problem with the American health care system has to do with coverage. In 2004, for example, while 245.3 million Americans (84.2%) had some type of health care coverage, 45.8 million (15.7%) were without coverage. Clusters of individuals that tend to lack coverage include employees of small business, workers who lose their jobs, workers who decline employer coverage, low-income parents, low-income childless adults, the near elderly, young adults, children, and immigrants. While incremental approaches could help particular groups, ultimately, the government needs to redesign the health care system to achieve nearly universal coverage. First, the exclusion for employer-paid health insurance premiums should be capped at a fixed-dollar amount and gradually replaced with a refundable tax credit. Second, employers should be required to offer, but not necessarily pay for, at least one state-approved health insurance plan for employees (an employer mandate). Finally, individuals should be required to get health insurance or lose tax benefits such as personal exemption and standard deduction (an individual mandate). With universal coverage, we should finally be able to reduce our health care system's burdensome administrative costs and get medical treatment costs under control, and we should be able to do so in a way that minimizes work disincentives. In short, we can make universal health care work.