Is Health Care Like Social Security?

Nurse and patient, Lib. of Cong.

In Tuesday’s Democratic debate and yesterday at a rally in Ohio, Senator Clinton made the argument that we should begin to think about universal health care the way we think about Social Security. Does she really mean it? From MSNBC:

Health care was at the top of the agenda as she previewed a speech later in the day on child poverty. "There’s a lot of people here who don’t have health care," said Bryan Holman, one of the residents.

She noted that "my opponent" tells people her health care plan would force people to buy insurance even if they can’t afford it and would fine them if they don’t. About half the time Clinton refers to Obama by name, the rest as "my opponent."

"That’s misleading, that’s not at all what’s happening," said Clinton.

"I have a plan that would cover everybody, my opponent does not. He would leave 15 million people out. It’s like Social Security. Everybody’s in Social Security. That’s what we have to do with health care."

Let’s assume that Mrs. Clinton did not mean health care should only be provided to those who reach retirement age. She supports universal coverage, so let’s take that as a given.

The essence of Social Security is that it functions as a universal national social compact. Each generation provides the funding for a retirement system for the previous generation when it reaches retirement age. Everyone who reaches retirement age is entitled to receive Social Security retirement benefits; it’s automatic. One need not be currently employed, and the system does not require that during your years of employment, you had some private investment/insurance plan such as a 401(k) or employer-specific plan. Whether you did or not doesn’t matter. The coverage is universal because you’re an American, or an eligible lawful resident.

The argument for a "mandate" then becomes a rational and necessary element of universal coverage. The "mandate" does not require you to "purchase retirement insurance" where and while you’re employed — that would be analogous to a mandatory version of the Bush/Republican plan for individual retirement accounts — something all Democrats wisely and universally rejected.

No, the "mandatory" part of this is that everyone has an obligation to pay for Social Security. Payments are through payroll taxes. It’s a simple concept: there is a mandate to pay taxes to support an essential service, and everyone must pay their "share."

The fairest allocation of the mandatory tax can be debated. We currently cap the income level on which the payroll tax applies; but we could lift that cap and have the tax apply more progressively. Like others, Senator Obama has proposed just this solution in the context of long-term funding of Social Security. There’s nothing illogical or radical about such an approach. Everyone understands it.

So what is Senator Clinton saying? Does she mean that every person should be entitled to health care as a matter of right? I think that’s what she’s said on several occasions. It’s a basic Democratic right. And to make sure we can pay what it costs for this universal right, we’re going to have to impose a tax on everyone — a mandate.

Just like Social Security, where everyone with an income is part of a social compact and must contribute to its costs, we will need a universal social compact to provide and pay for health care. We will pay taxes to provide an essential public service. Most people already agree with this principle when it’s applied to Medicare, Medicaid, SCHIP, Congressional/Executive Office health plans and so on.

When you strip away the so-far unhelpful debate about "mandates," that is the logic of Senator Clinton’s universal health care proposal. It also happens to be the logic of Senator Obama’s universal care proposal, at least when he talks about subsidizing care for those who cannot afford health insurance and requiring folks to purchase care for children.

Senator Clinton equating health care to Social Security is a a helpful development. It’s time for both of them to start describing their proposals in these terms and get beyond the silly debate they’ve been having.

Related posts:

1. Didn’t We Just Have a National Referendum on Obama’s Health Care Plan Last November?
2. Baucus Health Care Bill: In a Word, Awful
3. Poll: Public Option More Popular Than Health Care Reform
4. Mitt Romney’s Idea of Health Care Reform: Giving Big Insurance Whatever They Want
5. Poll on Possible Health Care Bill: Whither Progressives?