Title: Universal Health Care Explained

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Section/SPIG: Community Health Planning and Policy Development

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Remember the old saw about California, “If it’s going to happen, it will happen first in California?” That most populous of our states has been leading the way in many national trends for a long time now, so one wonders if it could now be a harbinger of the beginning of the first true universal health care system for the nation.

There have been parallels between California and the nation in this for at least 60 years. At about the time that President Truman was proposing to establish a national health care system, an idea shot down by the AMA, AHA, and Sen. Taft of Ohio among others, then Republican Governor (and later Chief Justice of the U.S. Supreme Court) Earl Warren was proposing it in California. Currently, State Sen. Sheila Kuehl (D-Santa Monica) is proposing single-payer legislation (SB 840) to provide a system in which the state government would provide health insurance to all.

Under this plan, the state’s residents would pay for their health care through their taxes instead of paying insurance premiums, and health insurance would no longer be sold in the state. That alone would excise an enormous cost from the state’s health care burden. As for hospitals and other providers, they would once again be paid under fee-for-service, an arrangement they should like better than being subject to so many administratively differing health plans. And the efficiency of having just one system with greatly reduced administrative costs (planning replaces marketing) and tremendous purchasing power over pharmaceuticals, medical devices, supplies, and equipment, would result in an affordable system covering everyone. Of course, its ability to truly cover everyone, and its ability to expend its resources on prevention and public health rather than on the profit motive, is what inspires those of us who still have the public interest at heart, and see health care as a right. In this view, it is fitting that individual means should be translated into the public purchasing power that can work for the public good, but that good will only be realized if legislators’ oversight of all the program’s parameters provides for continued commitment to those principles under which the program was originally established.

While advancing these ideas, it must also be admitted that government-run programs are always subject to all the pitfalls of politics. Like all government, this too must be government by the people, for the people. That means that it will work only so long as the people’s eternal vigilance provides the accountability to make government service a moral imperative. And in an era when “public” has been denigrated and “private” oversold, and taxes abhorred in favor of paying more out of individual motivation and discretion, it will be easy for conservatives and the private sector to instill fear in voters just as they did with the Clinton Plan in 1994, and also with another single-payer legislative initiative that failed in California at the same time.

Computing Cost Savings/Affordability



The National Coalition on Health Care (NCHC) has studied various scenarios for providing universal health care and has analyzed four of them intensively.

  1. Employer mandate supplemented by individual mandates where necessary.

  2. Expansion of existing programs that currently provide coverage to defined populations.

  3. Development of a new program modeled after the Federal Employees Health Benefit Program (FEHBP).

  4. A universal, publicly financed, single-payer program.



All four approaches to universal health care would result in overall cost savings nationally out of the same efficiencies California wishes to realize. The NCHC employed Professor Kenneth Thorpe of Emory University to compute the savings that would be projected to accrue from operationalizing each plan. Thorpe projected that the cost savings in each plan’s tenth year (2015) would range from $125 billion to $182 billion. He also made projections for the total change in spending (i.e., the cumulative savings) for each in comparison with the nation’s present “system” for the years 2006 through 2015, and came up with the following figures:

  1. $320 billion reduction.

  2. $320 billion reduction.

  3. $370 billion reduction.

  4. $1,136 billion ($1.136 trillion) reduction.



These net savings accrue even after taking into account the increases in federal spending needed to secure universal coverage. The Thorpe report summarizes the impact of these plans on national health care spending as follows:

System-wide health care reform, along the lines that the Coalition’s specifications envision, would produce substantial reductions in national health care spending — reductions that would begin soon after reforms were phased in and that would increase over time.

As projected by the Centers for Medicare and Medicaid Services, national health care spending would be expected to rise under current law — that is, in the absence of major health care reform — from nearly $2.1 trillion in 2006 to more than $3.8 trillion in 2015. That means that the proportion of our gross domestic product devoted to health care spending would jump from about 15.6 percent now to 19 percent in 2015 — an increase of 3.4 percentage points. (On p.12 of the Thorpe report).


Public Health vs. the Profit Motive



Universal Health Care can be more than just efficient in its use of public resources. It can serve the greatest good by taking two more radical steps.

  • Adopting a public health model for its goals and priorities.

  • Eliminating the profit motive from health care.



Making public health a national priority means empowering communities to support the best possible health status for everyone in them. This gives us a set of imperatives sorely missing from today’s health care: To provide health education as a fundamental part of everyone’s right to public education so that they may become promoters of their own wellness; to foster health promotion, primary care, and disease prevention; and to enable all community members to understand and participate in public forums on health policy.

The principles of compassion, fairness and social justice that define public health are incompatible with the profit motive in health care. Rather, the resources taken out of the community to fund health care should be returned as benefits to the community.


This article is also posted at http://www.ahpanet.org/Health_policies.html#Universal.