From the
New York Review of Books overview by Paul Krugman and Robin Wells of the health insurance crisis and what should be done about it:
We're talking about large cost savings. Indeed, the available evidence suggests that if the United States were to replace its current complex mix of health insurance systems with standardized, universal coverage, the savings would be so large that we could cover all those currently uninsured, yet end up spending less overall. That's what happened in Taiwan, which adopted a single-payer system in 1995: the percentage of the population with health insurance soared from 57 percent to 97 percent, yet health care costs actually grew more slowly than one would have predicted from trends before the change in system.
They make it clear that the path to reform won’t be easy, given the tenacity of the special interests and the cowardice of our elected representatives.
We believe that the compromise plans being proposed by the cautious reformers would run into the same political problems, and that it would be politically smarter as well as economically superior to go for broke: to propose a straightforward single-payer system, and try to sell voters on the huge advantages such a system would bring. But this would mean taking on the drug and insurance companies rather than trying to co-opt them, and even progressive policy wonks, let alone Democratic politicians, still seem too timid to do that.
So what will really happen to American health care? Many people in this field believe that in the end America will end up with national health insurance, and perhaps with a lot of direct government provision of health care, simply because nothing else works. But things may have to get much worse before reality can break through the combination of powerful interest groups and free-market ideology.
My question is this: Given that our current system seems to be falling apart faster than we can patch it (employers dropping health plans, employees facing rising costs, not to mention the growing numbers of uninsured) and given that there’s no plan for a new system that seems to have any widespread political support, why not start with an existing system that works?
Someday we’ll have universal, single-payer coverage. Why not build a bridge to that outcome by lowering the eligibility age for our current, successful single payer system — Medicare — by a few years each year?
Millions of older workers are working only for the insurance and would retire, work part time at something else, or start their own businesses if they could. Making them eligible for Medicare would create jobs and spur economic activity. Taking older, less healthy workers out of the system would reduce financial pressures on employers and employees alike.
In short, we would begin to relieve the crazy pressures that are building up, while buying time and perhaps some political space to craft a stable long-term solution.