Analysis: Four ways to cover all

WASHINGTON, July 17 (UPI) -- As the movement for universal health insurance gains momentum, health policy experts took on the more difficult task of finding a way to achieve that goal and presented four possible options Tuesday.

Although each aims to expand coverage, the tools used to do so vary widely.

"Universal healthcare reform is the most important step we can take to increase the economic security of American families," former U.S. Treasury Secretary Robert Rubin said at a panel discussion hosted by the Hamilton Project, a program at the Brookings Institution, a non-partisan think tank.

In looking for a solution to today's problems, though, policymakers should build on systems already in place and be wary of overly complex and convoluted proposals, said Gerard Andersen, a professor at the Johns Hopkins Bloomberg School of Public Health.

"The longer I'm around D.C., the more complicated the health insurance bills become," he said.

As a result, Andersen and co-author Hugh Waters suggest expanding the Medicare program and requiring anyone who does not have private insurance to buy into it.

Those who chose to opt into the Medicare plan would receive the same benefits offered in today's Medicare plan. A flat-rate premium would be charged to everyone, but low-income families would receive a subsidy set on a sliding scale.

Although problems exist in the Medicare system, Andersen said the familiarity of the program is the main advantage to his plan.

"It represents a system that has been scrutinized for over 40 years," he said. "Any new program is going to have unexpected problems."

The program could also reduce costs for the average family, Andersen said, because public health programs tend to have lower administrative costs -- about a third of those incurred by private insurance.

But those low prices might not last long if the program grows, said Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology. Currently, the government pays less than the average price for treatment.

However, "If you start putting everybody in Medicare, doctors won't accept the pay anymore," Gruber said.

The plan proposed by Gruber also requires all individuals to acquire health insurance but relies heavily on private health insurance. The plan closely resembles the Massachusetts healthcare plan, which went into effect July 1.

Like the state's new plan, Gruber's proposal calls for employers to make contributions to their employees' coverage and creates "HealthMarts," or state-run systems that connect buyers with good insurance plans for their needs. The plan also provides subsidies for low-income individuals.

The individual mandate plays an important role in the plan because it forces those with good health and low healthcare bills to share the costs incurred by sicker individuals, Gruber said.

"With no mandate, the same plan will cover only 40 percent of the people, but at three-fourths of the cost," he said.

However, including a mandate in healthcare reform could act as a "political lightning rod," said Stuart Butler, vice president of domestic and economic policy studies at The Heritage Foundation, a conservative think tank.

"A mandate means getting someone to do something they don't want to do otherwise," Butler said.

Incentives would be a more feasible way of achieving universal coverage, he said. The plan proposed by Butler attempts to make health insurance more available for those who move from job to job, as well as the self-employed.

Like the Massachusetts plan, Butler's proposal would establish a connector, or exchange service, to facilitate the purchase of plans, allowing people to keep the same plan even if they switched jobs. The plan would also encourage the creation of diverse insurance pools and switch the employer role from sponsor to facilitator.

Most of the reform would occur at the state level but would require some important changes on the federal level as well, Butler said.

"I think the federal government should immediately try to fix the perverse incentives of the federal tax system," he told United Press International.

Under Butler's proposal, the same tax exemptions given to employer-sponsored health plans would also be available for the non-employer plans offered through the exchange services.

The fourth plan calls for more dramatic action on the part of the federal government. A voucher would be given to every individual that would be sufficient to purchase a plan with benefits comparable to those given to members of Congress. People would be able to decide which health insurance plan to buy with the voucher.

The plan would be paid for by an increase in taxes but would result in cost savings because public programs like Medicare and Medicaid would be unnecessary and individuals would incur no out-of-pocket expenses unless they decided to buy extra services, said Ezekiel Emanuel, the plan's co-author.

"The voucher proposal will cost the same as the current amount spent in the United States on healthcare," said Emanuel, chair of the department of bioethics at the National Institutes of Health, an agency of the U.S. Department of Health and Human Services. "The voucher proposal ... emphasizes equality because everyone gets the same standard benefit package, but it also highly emphasizes individual freedom by giving people the choice of the health plan they want."