Claiming that "We cannot afford a healthcare system that doesn't cover every American -- the cost to our economy and the well-being of our people is just too high," Bill Richardson released his health care plan on Tuesday to surprisingly little attention. If Republicans have coalesced around tax deductions for private insurance and health savings accounts, Democrats seem to be uniting around a mandate to purchase insurance and marketplace choice -- his proposal is similar in many respects to those already put forward by Barack Obama and John Edwards.
In case you missed it, here follow some highlights of a plan that, "understands the importance and power of consumer choice, building effective markets and decentralized solutions rather than new government programs and bureaucracy," if the plan may say so itself.
In a Richardsonian order, every American will be required to purchase health insurance. Those who have insurance already -- including small business owners and the self-employed -- can keep that policy, or they can buy a government-sponsored plan, "the same coverage that members of Congress enjoy." Those 55 and older have an additional option: early enrollment in Medicare. People under 25 can remain on their parents' policy, even if they're not students. For veterans, Richardson promises to improve the VA, but they, too, can purchase swanky, Congressional-style insurance.
Americans who can't afford the coverage that Congress is accustomed to (note: policies don't come with free parking at Washington National Airport) will get a sliding-scale tax credit -- not a deduction, as Republican Giuliani would have it -- to help offset the out-of-pocket cost. The cost: up to $110 billion. Like rival John Edwards, Richardson will make businesses pay a portion of their employees' insurance premiums, either through their existing policies or through a "contribution" that depends on the size of the business. Unlike Edwards, Richardson does not call this a tax increase, and further insists that his plan doesn't require raising taxes at all. Rather, he'd pay for it through "efficiencies:" discount drug pricing for Medicare, health information technology, and the like.
You can read the executive summary or download the whole (and rigorously annotated) document here. In the complete plan, Richardson makes a couple points of interest to cost-conscious small-business people. First, we're all paying for the uninsured -- who get their medical care the expensive way, in emergency rooms -- through higher premiums and taxes. Richardson points to a study by Families USA concluding that without universal coverage, those families with insurance will pay on average $1,502 more in annual premiums by 2010 to absorb the costs of the uninsured. Secondly, "businesses that provide coverage are being forced to compete with businesses that do not, by indirectly covering the health care costs of other businesses' workers."
If the scheme sounds not especially radical, that's by design. "I think you have to pass this plan with moderate Republicans, you can't just do it with Democrats," he told a reporter. Mandating insurance was precisely the road taken by Republican candidate Mitt Romney when he was governor of Massachusetts. And if I heard right at Sunday's Republican debate in Des Moines, at least one aspect of Richardson's plan would have the support of former Arkansas governor Mike Huckabee:
HUCKABEE: You know, if you want to know how to fix [health care], I've got a solution. Either give every American the same kind of health care that Congress has, or make Congress have the same kind of health care that every American has. They'll get it fixed.
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