What we don't talk about when we talk about healthcare reform

"Universal coverage" is all the rage. Obama proposes "coverage for all Americans" and Clinton proposes the "American Health Choices Plan", but with minor differences they're talking about the same thing: methods of ensuring that all Americans can and do purchase health insurance from private companies.

That's a long way from a government-run single-payer health care system, and it means a continued leach of money from consumers and providers of health care services to insurance companies. You might as well call it an all-out subsidy for the health insurance industry. During the re-Super-Tuesday debate, Clinton dismissed a single payer system by simply calling it "for many reasons, difficult to achieve". Well, what the heck does that mean? And why?

Neither Clinton or Obama will go into the "many reasons," but I want to discuss just two here. We need to put these out on the table because without an open discussion of these obstacles, we will surely never have a rational health care system in the US.

First, as I understand it, the insurance industry is a, if not, the major source of investment capital in this country. The health insurance sector makes up a significant proportion of the industry, and therefore, a significant proportion of the available capital. The investment capital comes from the premiums we pay in that are not used to pay out claims (this is the industry's main profit source). In effect, individuals and employers provide the main source of capital for private investors in the US.

A single-payer system that removed the insurance industry from the game would deal a serious hit to the overall availability of investment capital in the US. What would the impact on our economy be exactly? What alternative sources of capital could be found? Do we have any responsibility to continue providing this investment capital via our health insurance premiums?

Second, the availability of health insurance coverage is a key factor for employees who are considering job changes. We have all overstayed jobs because of the health insurance, or endured mildly (or very) oppressive conditions because we couldn't afford to lose our health insurance. Employers complain about the costs of health insurance, but the current employment-based system works very much to their advantage in terms of employee retention, and bargaining power with both organized and non-union workers.

I'd like to hear some proposals that actually address these and other obstacles and discuss how they might be overcome.