Where does health care reform go from here?

What's the next step in the health care reform process? Well, despite passionate debate that sometimes has not reflected the best the United States has to offer, it has to go in the direction of universal health insurance. Here's why:

The U.S.'s current health care system has led to the worst care rate and the worst cost structure among advanced, industrialized democracies. One can quibble about the forecast, but a good estimate puts the number of Americans without health insurance at 45-47 million, and increasing at a rate of 450,000-500,000 per month.

Among these, an estimated 10-12 million routinely access initial health care at hospital emergency rooms, and their costs are passed on by hospitals to paying patients, corporations, and insurers. If not addressed, this systemic flaw, combined with rising costs for Medicaid, Medicare, and other inefficiencies, will balloon the federal budget deficit and push corporate health insurance premiums to stratospheric levels.
Only two reform options for U.S.

Only two reform options are available for the United States: 1) incorporate the uninsured into the health care system; or 2) ban the uninsured and others who can't pay their hospital bills from accessing the system.

Let's consider option 2. Many conservatives have said this is the route the health care system should take: you want health care, you pay for it! There: that solves it! Prevent those who can't pay for care from accessing the system and you eliminate a large percentage of the system's rising costs. And these proponents say it's the only fair policy. Of course, individual doctors would still be able to work-out private, reduced-fee arrangements with those uninsured they choose to treat, but there would be no mandates. No doctor would be forced to provide lower-cost services, and doctors would be free to charge as much as they like per patient.

The problem will the above tactic is that some uninsured will still seek care at emergency rooms - undermining the ban's effectiveness. Unless the ban is universal and enforced rigorously, the costs of treating the uninsured will continue to balloon health care costs.

And there's another reason for not going the 'ban the uninsured' route: it's not only not credible, it's barbaric. No advanced, affluent, just, compassionate democracy and society treats its citizens that way.

Incorporating the uninsured into the system via health insurance (public and/or private) that they can afford, with monthly premiums subsidized by the federal government for lower-income citizens, comprehensively addresses the problem of the uninsured. That's the route U.S. health care reform must take.

Financial Editor Joseph Lazzaro is writing a book on the U.S. presidency and the U.S. economy.
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