Organizers of Cover the Uninsured Week, March 10-16, sure got our attention.
Studies came flying at us from hundreds of media outlets. The numbers were grim.
Perhaps most significantly, on March 10, an officer of the conservative and politically influential Heritage Foundation testified before a Senate committee that a "social contract" exists in the United States to "ensure all residents have affordable access to at least basic health care . . . "
So now, even the Heritage Foundation accepts the idea of universal coverage. Actually, Stuart Butler, the think tank's vice president of domestic and economic policy studies, said in a telephone interview a week after he testified that he'd written the introduction 10 years ago to a Heritage paper predicting the coming of an irresistible societal pressure for universal coverage. "I think we've reached that stage in our society," he said.
Butler concedes it would take a public/private partnership to cover everyone, but his plan, presented to the Senate subcommittee on aging, calls for phasing out what he calls the "regressive" tax breaks given on employer contributions to healthcare benefit plans. The excluded federal and state income and payroll taxes--estimated at $125 billion in 1988--would be better spent, he argues, providing "more progressive" tax credits or subsidies to individuals for obtaining health insurance themselves.
Butler did not urge employers to stop paying for their employees' healthcare coverage, but that is inevitably what would happen without the tax breaks. In my view, Butler was passing out parachutes and shouting "Go!" to nervous corporate executives now only contemplating a bailout of the sputtering plane that is employer-sponsored healthcare coverage.
What he is proposing would be a profound change to a key component of the U.S. healthcare system. Whether physician executives should support or oppose Butler's plan, I'll leave to the individual. But given the clout of the Heritage Foundation and the sweep of the proposal, I suggest physician leaders might want to keep an eye on it.
In 2001, employer-sponsored programs covered roughly 62% of all Americans (176 million) and 88% of those enrolled in private health plans, which paid $496 billion in medical bills, or 36% of our $1.37 trillion in total healthcare spending, according to the U.S Census Bureau.
If enacted, the Butler plan will change the way physician leaders do business, since it would put the current weak shift toward consumer-driven healthcare on steroids. Customer service and retail marketing, already important, would become critical to survival in a buyer-driven market.
Physician executives are well-positioned to drive the debate over the form and function of any expanded coverage system. So get ready.
The irresistible pressure is building.