Panel Says Americans Should Be Required to Have Insurance

Published November 1, 2006

The federal government should require all Americans to have basic health care coverage, a federal advisory panel stated in its final recommendations released on September 25.

The 14-member Citizens’ Health Care Working Group, created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, concluded, “Health care is a shared social responsibility”–a concept requiring financial contributions from all citizens.

After soliciting feedback from citizens, public officials, and stakeholders, the group had released an interim report in June, which offered six recommendations for improving a system it called “unintelligible” to most people.

After the release of the final recommendations, President George W. Bush has 45 days to submit his comments to Congress. Five congressional committees will hold hearings on the president’s report and the group’s recommendations.

‘Efficient’ Rationing

The final report recommends all Americans be guaranteed access to “a set of core health care services” to be determined by an independent, nonpartisan group. Decisions about what to include in the core set of services would be made by considering “evidence-based science” and “expert-consensus regarding the medical effectiveness of treatments,” the report recommended.

According to the report, “Health care spending needs to be considered in the context of other societal needs and responsibilities. Because resources for health care spending are not unlimited, the efficient use of public and private resources is critical.”

The final recommendations offer two potential systems that would meet the requirement for universal protection.

Under the first, called the “market-based model,” citizens would be offered a choice of standardized insurance products with varying deductibles and premiums. The “social insurance model,” by contrast, would be a federal program administered like Medicare and funded through a combination of federal funds and consumer-paid insurance premiums.

Both models would offer subsidies to low-income citizens.

Scary Proposal

Free-market analysts were highly critical of the recommendations.

“The idea is that someone, somewhere, gets to decide whether to use taxpayer dollars to pay for your medical services,” said Twila Brase, president of the Citizens’ Council on Health Care, a watchdog organization that promotes free-market health care policy. “Patients should be scared to death.”

Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons (AAPS), said the recommendations, if implemented, would make it more difficult for people to get the care they want or need.

When the market is controlled by monopolies or government forces, Orient explained, physicians have little incentive for bringing their services to market. In addition, Orient said, requiring all citizens to purchase health insurance will further reduce incentives for the insurance industry and health care providers to create effective, market-driven solutions to problems of access or cost.

Government Involvement

In support of the plan, Richard Frank, a member of the working group and professor of health economics at Harvard University, said citizens might be willing to incur greater costs to guarantee “health security”–protection against rising costs of medical services and insurance.

Americans of diverse backgrounds share common concerns about health care, Frank said, “and people realize that something important should be done.” The greatest challenge, he said, is defining a viable solution.

“This plan is the ultimate conflict of interest,” said Brase, because the same entity that takes a taxpayer’s money will define his or her access to care. “It will inevitably lead to the rationing of care,” Brase said.

Frank acknowledged some people would be disadvantaged by a federal requirement to purchase health care. He called the predicament “a tricky balancing act.”

Critics such as Brase and Orient point out the system would require citizens to buy a product that might not fit their needs. Orient called the group’s recommendations “just more of the same failed pathway that has led to greater government intervention in medicine, redistribution of income, and prepaid medical care,” none of which is good for the patient.

Hilary Masell Oswald ([email protected]) is a freelance writer in Evanston, Illinois.

For more information …

“Health Care That Works for All Americans,” Citizens’ Health Care Working Group, September 25, 2006,