The goal must be to build a health care system that provides high quality preventive and curative health care to every American as a right, not a privilege, and to do so in the context of a cost containment program that makes the system affordable to individual Americans and their families, and to our government at all levels: local, state and federal.

Such an affordable, universally-accessible health care system has two components: the insurance or funding component and the health care delivery component. This proposal addresses both of these elements.


In an ideal world, we think the goal of affordable universal health care can be best achieved with the government acting as the single public insurer for all Americans and with all Americans free to choose their own private providers of health care. We believe that “the single payer system” can achieve the minimum administrative costs and can best provide universal coverage at affordable prices.

However, we recognize that we do not live in an ideal world and that one has to work within the historical and political context that has developed in the U.S. with regard to health care. Therefore:

• While we advocate that such government programs as Medicare, Medicaid, S-CHIP, the Federal Employees health plan and the Veterans Administration health system all should be expanded as quickly as feasible to cover as many as possible, we also recognize that these programs will not, at any time in the foreseeable future, cover all those not now covered by any private insurance program.
• We recognize that many of those who currently are covered by private insurance plans suffer from:
  

1. inadequate coverage of many illnesses and conditions, including mental, dental, vision and hearing health needs,
2. unacceptably high costs for premiums and deductibles, and/or
3. a lack of guaranteed coverage at a reasonable cost if they lose their jobs or if they experience a catastrophic illness or injury that tempts the insurance provider to limit or terminate coverage.
   

• We recognize that many of those who do currently have private health insurance wish to continue their coverage and want to continue to have the ability to choose their own health providers, at least to the extent they now can do so.
• We recognize that there are hundreds of thousands of Americans currently working for private health insurance firms. These individuals could not be absorbed quickly by a new or expanded government insurance provider, should the private sector be suddenly constricted, especially given the current economic crisis.
  

Therefore, as a practical matter, the Claremont Democratic Club advocates that at this point in history President Obama and his Administration work with Congress to implement a public – private partnership to provide affordable universal health insurance to all Americans and legal residents. We leave for a separate discussion the issue of health care for illegal immigrants.


The Claremont Democratic Club believes that the key requirement for the success of a public-private partnership is that all private firms that provide health insurance must be treated as “public utilities”; that is, any responsible, affordable, universal health care system must closely regulate the prices, profit margins, eligibility and coverage offered by all private health insurance providers. To this end, we recommend the following standards:

• All health insurance providers, public and private, must be required to cover all health risks:

• physical and mental/emotional,
• pregnancy and end of life,
• vision, hearing and dental,
• preventive, curative and rehabilitative/physical therapy
• medicines and medical supplies
  

• Private insurance providers, as well as the government, must offer coverage to all persons regardless of age, health, occupational risk or employment status, both as a matter of fairness and to pool the risks.
• The Federal Government must create a new public health insurance program that would be available, voluntarily, to any American or legal resident who chooses to participate, including individuals, families and employer/employee groups. At the same time, everyone should be free to choose to (or continue to) purchase health insurance from a for-profit or not-for-profit private firm, either in cooperation with their employer or alone. We reject as inadequate the option of regional public insurance programs or coops since they can not achieve the level of bargaining power needed to assure low costs.
• However, all Americans and all persons legally resident in the United States, and their children, must be required, as a matter of law, to be enrolled in a health insurance program that is equivalent in its coverage to the one offered by the government. (Again, we leave to another discussion the issue of health care for illegal residents.) Only with such a mandate can we guarantee the broadest possible pool, and hence the broad spreading of risk, that will keep the costs of insurance, public or private, at reasonable levels. We do not exempt younger workers from Social Security, Medicare, or Unemployment insurance programs, and they should not be exempted from participation in a basic health insurance program. Aside from the matter of spreading the costs, our nation’s public health and safety requires that all participate.
• The schedules of premiums and deductibles for all private insurance programs, as well as for the public insurance program, should not be based on prior or current health conditions, age, gender, occupational risk or employment status, as they are today. Instead the prices/fees be must be based only upon the health care costs in a general geographical area. That is, the cost of insurance must only be community based. Thus, having pooled the risks, each private insurance firm must charge the same rates to young and old, the ill and the healthy, the employed and the unemployed, within a given geographical area.
• However, within these constraints, individual private insurance companies may have different premium schedules and different deductible and co-pay schedules, subject to the limitation of a profit margin of no more than 5%.
  

• The government must also monitor and set limits on allowable “overhead costs,” since this category is often used to pad profit margins

• The geographic-based price/fee schedule set by the government for its insurance program must be subsidized on a sliding scale, from general tax revenues, to guarantee viable access to the poor and middle class and to individuals in special categories, such as veterans not covered by the Veterans Administration medical system.

• The Democratic Club of Claremont recommends that the source of this tax revenue be a Value-Added Tax, similar in design to that used by virtually all European nations.

• Within the context of a public-private partnership, the same schedule of subsidies must also be made available to persons who wish to buy their health insurance from private for-profit or not-for-profit health insurance firms. The failure to provide such subsidies would effectively close off the option for the poor and middle-class to purchase private health insurance and would contradict the concept of a private-public partnership.

The Democratic Club of Claremont believes that it is practical, politically achievable, affordable, and indeed necessary to the well-being and economic viability of our nation and its people that the Obama Administration and Congress move as quickly as possible to implement an affordable, universally accessible, high quality health care system based upon the principles enumerated above.