Universal Coverage for the People's Republic of North Carolina?

The following was found in an e-mail advisory I received yesterday from NC Spin:

Governor working on Universal Health Care Plan

...Governor Mike Easley has asked the Department of Health and Human Services to crunch numbers regarding a proposal for an individual universal health care plan to cover all our citizens. The goal, we heard was to include this plan in the Easley budget proposals to be submitted to the legislature soon. The sketchy details we get are that the coverage will be mandatory and will be financed by employer payroll taxes. Massachusetts and California are currently working on similar plans.

It is well established that North Carolina is a leftward-leaning state compared with much of the rest of the southern United States.  That it would be the first in the region to toy with universal coverage is at once unsurprising, but alarming.

According to Michael Cannon in his book "Healthy Competition", which I previously reviewed here, California had a bond referendum in 2004 that would have required an employer mandate, or a tax on employers who did not provide this insurance.   Studies suggested that individuals earning $31,000 would see their after-tax income drop by 7%; families earning the same amount, by 17%.  38-45% of targeted workers would have lost their jobs.   

To respond to this imposed cost, employers would raise their prices and outsource more functions.  They might be tempted to cut wages, or hire more part-timers who would be ineligible.   Some workers would seek jobs that do not offer insurance, instead seeking higher wages. 

But another concern is with respect to  job creation in North Carolina.  Many employers would surely think twice before locating here, when these costs can be avoided elsewhere.  Losses of potential new jobs could be substantial.

Already we are hearing some voices asking hard questions about what is happening with the new Massachusetts plan and the  California proposal.  Even Robert Samuelson of Newsweek is getting in on the fun.

North Carolina's consideration of such a plan would be of momentous significance.  If NC Spin's report is accurate, Mike Easley is treading on perilous turf.  Contrary to what our one-party government in Raleigh would have us believe, sometimes it is best to refrain from imitating Massachusetts and California.

Comments

[Cara Michele]

Joe, I promise that I'm not trying to do this on purpose, but we're about to disagree again. ;) I'm thrilled with this news!! I hear your "sky is falling" scenario, and you may be right (I bow to your superior knowledge here), but I'm excited to hear that our governor is at least exploring the possibilities of universal healthcare. Who knows? Maybe he'll find a way! What I do know is how huge the need is for universal healthcare, not just in our state, but in our nation. So, I'm praying... :)

[Brenda Bowers]

At the very least NC should wait for a better assessment of the other programs out there. Of course I have gone on record for decades with the proposal to take well off seniors off of Medicare (now 25% of the federal budget!!) and then work on expanding Medicaid to cover the poor either with the system as it is today or a combination of care for the poorest and help on a sliding scale with insurance premiums for the lower economic bracket. But the key is to drop well off seniors from Medicare! And to make the Senior Drug plan only avaible to needy elderly. It is time for Americans to stop people who have the bad manners to get old from living off of the young of this generation and the next. (PS: for those of you who may not know I am 65 and my husband is 69 so I have a right to say what I want to on this issue.)

[Dr. Mary Johnson]

Cara, I wish I could share your optimism, but Mike Easley has his sights on the national stage. "Exploring" universal healthcare is the ticket.

Alas "exploration" is all that will happen. Because "fixing" this mess we're in is a complex, multi-layered job - that will step on a lot of toes. And it's a job no one really has the cahoones to do.

Healthcare is becoming the third rail.

[Joe Guarino]

Michele, I always appreciate your comments even when we disagree. It livens up the blog. And I know your heart is in the right place, even though our judgments sometimes vary.

Brenda, Medicare's severe problems are a classic example of why our state government should think twice, and real hard, about this potential future plan.

[Joe Guarino]

Mary, health care has already been a third rail, as you know, and will continue to be one. But the disheartening aspect of this is that, even absent Easley's proposal, we are incrementally migrating toward socialist medicine anyway.

[Sue]

Joe: "It is well established that North Carolina is a leftward-leaning state compared with much of the rest of the southern United States."

Joe, LEFTward? Two Repub Senators, a state that votes Repub statewide in recent years, albeit a Dem Governor... where do you get "well-established?"

But conversely, what would you have the leadership do? IGNORE health care or embark on exploration toward finding out how to get health care to the citizens of NC? Either you keep the status quo or you seek to make changes. You're writing off an exploration that might just make life better for a lot of people while quoting numbers that have not yet been proved.

It's easy to criticize. What's your alternative plan? Democracy has been about protecting the weakest, not the strongest, among us. Is it Democracy you're against, is it the people of North Carolina who are at risk every day, or is it that you just hate America?

[Translation: wide evil grin; aka humor]

[Joe Guarino]

Sue, I love democracy, and I love America. Unfortunately, Mike Easley did not run on universal health care during his last gubernatorial campaign. If he had, it would have given the voters an opportunity to size him up on the basis of advocating such a drastic change. Instead, it may be sprung on us by surprise despite not having been vetted during a campaign.

I have posted previously on the approaches I would consider with respect to health care reform.

North Carolina has tended to often vote Republican at the national level; but at the local and state level, it is nearly solid Democratic. In addition, the types of approaches seen at the local (especially here) and state level tend to lean more Democratic--especially when compared with the rest of the South.

We don't have universal housing, universal food, universal transportation or universal clothing. I think the burden is on those that advocate this change to demonstrate why it is so imperative to have universal healthcare before we have these things. And I think the burden is also on advocates to demonstrate why the adverse impacts I mention will not occur.

[Dr. Mary Johnson]

Sue, it makes me sick the way you framed that question. I know the Democrats can do no wrong in your book, but it's a FACT that the Democratic Party runs this state.

And they have run healthcare into the ground. Do you remember when I was jumping up and down about the "disproportionate share" program . . . a case where the geniuses at NCDHHS just handed a program (financed by Medicaid that reimbursed hospitals for indigent care) over to the well-connected big boys in Charlotte? By some reports, nearly a billion dollars of the taxpayer's money was misappropriated. Barely got a smudge of a mention in the papers. The FBI finally took a look, but in the end NO ONE was prosecuted . . . it was all a series of unfortunate/"unintentional oversights" and accounting errors. I expect the case was just too complicated to prosecute. As far as I know, none of the accountants or lawyers or politicians involved even got fired for their incompetence.

Where "indigent" care is concerned, was anybody in Raleigh looking beyond short term profit when the "hotlines" to Mexico put the word out that North Carolina industries would wink and nod when they hired? Did any of the suits counting their money give ANY consideration at all to the trememdous burdens this would place on already saturated medical and educational systems? Of course the babies born to illegal immigrant are slapped right on Medicaid - becoming pawns in the system and "anchors" for their parents. Who pays for that? Why you and I. You can't talk about it now . . . because if you do, you risk offending a voting block - or being labelled a "racist" (enter the N&R).

In this era of looming doctor shortages, my own sad story gives ample testimony to the fact that the "loan repayment for service" programs that John Edwards is touting can be warped beyond any reasonable notion of accountability. It's glorified indentured servitude - with no way out for the physician who finds him/herself in a bad situation. Edwards (a Democrat) had a doctor screwed by such a "public service" program right under his nose . . . jumping up and down and screaming for help . . . did he do anything? Has he done anything? No.

I'd LOVE for someone to really "explore" all of this . . . how so many things went wrong. But no one really wants to talk about it. They want to "look to the future" - as if you can fix the future without taking a hard honest look at the past.

The N&O did an excellent article fairly recently confirming what some of us have known all along . . . that our national (Republican) reps actually have little power in Washington. I blogged on it. But you don't read my blog.

I don't advocate "ignoring" anything. And I'm sure Joe doesn't either (and his point about universals is well-taken). But in our jobs, we live every single day with the sorry results of someone else's usually politically-motivated bad ideas. You wanna "fix" healthcare? You'd go along way if you'd concentrate on real (personal) accountablity and genuine charity in the system we have - because as much as everyone whines - it really is the best in the world.

As much as the lawyers might love the ultimate "deep pocket" to sue, our system will not stay the best in the world if it becomes a "universal" government-run factory as opposed to a free/competitive/open market.

You "fix" things by listening to those of us on the front lines every day - those who fight "the war". But our own advocacy organizations are totally off that track, the politicians have to be bought to listen (I've blogged on that too), and the newspapers turn a deal ear.

[Sue]

Mary: "...but it's a FACT that the Democratic Party runs this state."

Got a source? A citation? Something that's not opinion?

[Fred Gregory]

Oh what the heck Joe, haven't you heard Happy days Are Here Again. Terry Grier wants Guilford county property owners to fund universal college education . The Feds already dole out Pell Grants to approx 5 million students. From each according to his means , to each according to his needs.
Why some people wanna be like France is beyond me

[Jim Caserta]

Why is it when conservatives mention either California or Massachusets, it's always negatively? Are California communities begging NC companies to move there - http://valleywag.com/tech/google/north-carolinas-blind-date-233489.php? CA has been the heart of much of the technological advancements of the US over the past 40 years. MA is the site of much of the advancements in pharmaceuticals. These are two of the most liberal states in the union, but maintain more than their share of the horsepower of the country's economic engine. I just don't see any correlation between liberal economic policies and a stifling of economic growth.

I think almost all Americans agree that community hospitals should not turn away sick patients. However, too much primary care happens in ER's and there are problems with patient compliance and general health maintenance. I would directly address the problems with health care instead of dismantling the current program and gambling that a new system would work better.

[Dr. Mary Johnson]

We're talking about healthcare here, Sue. Not whether or not you're in (total) denial about how we got in the boat we're in . . . and who has been piloting the political train in Raleigh that chugged us all here.

[Joe Guarino]

Jim, virtually the entire history of the accelerated industrialization of the South during the mid-to-latter part of the 20th century was based on Northern industrialists locating operations here, partially to evade higher labor costs and taxes up North. Now, employers can oft set up operations and use labor overseas. There is significant competition for good jobs. Rational business people are going to make decisions based on economics.

California has had natural assets drawing people there for a long time. The taxation/regulatory level in Massachusetts is now equivalent to North Carolina, but may spike higher once again now that its universal coverage plan is in place. Certainly various parts of the country have human and capital assets that keep their regional economies chugging along.

If all other factors are held constant, however, we must compete based on economics.

[sean coon]

ok, let's talk economics; what's your position on how this tax money was spent?

http://www.youtube.com/watch?v=sYcNhjRme7E

[Jim Caserta]

Joe, your economic outlook is like the manager who thinks the only way to grow profits is to cut costs. California's successes cannot be explained by their natural assets, but by the creative people that live there. As an example, my company has a much harder time recruiting engineers to their Greensboro office than either San Jose or Boston. Is that because the engineers are irrational?

CA & MA are investing in their future, and many people want to be a part of that. The end of the 20th century showed that the 21st will be much different, we should be pushing NC's economy into the 21st, not dragging it back to the 20th.

[Joe Guarino]

Sean, there have been concerns expressed that at least some of the money used in Iraq was not spent wisely in a manner that represented good stewardship. I would oppose that. But I do not oppose what our overall objectives had been in Iraq.

Jim, I don't think we can assume that the usual economic principles that drive employers' decisions are automatically invalidated. North Carolina tries to overcome its other deficiencies in the eyes of employers by granting sometimes massive incentive programs.

[Fred Gregory]

Well our ex Senator , that mo-ron John Edwards wants to give us Hillarycare.

http://today.reuters.com/news/articlenews.aspx?type=politicsNews&storyID=2007-02-04T171930Z_01_N04358318_RTRUKOC_0_US-USA-POLITICS-EDWARDS.xml&WTmodLoc=PolNewsHome_C1_%5BFeed%5D-3

What a dummy. He wants the brokerage houses to report to the IRS all those obsecene capital gains that are going untaxed and uncollected . ( like that is not being done daily ) Six years in the Senate and he doesn't know that if sell this H.J. Heinz stock I have held for 40 years the gain will be reportesd to the IRS in a mili second on a 1099-Div and I damn better file a Schedule D and cough up the amount due. He really is an a populist empty suit living in a $6 million Jed Clampett mansion with a big cement pond.
Asshat !

[Joe Guarino]

Fred, we have been hearing for years about how the Bush tax cuts affecting higher wage earners has severely exacerbated the deficit. Of course, if Edwards plans to take back those tax cuts to pay for universal health care, the deficit remains.

It is very necessary, with any of these proposals, to consider the manner in which the programs will spiral out of control beyond initial projections-- which tends to happen with entitlement programs.

[Fred Gregory]

Yeah Joe, like this:

http://www.fns.usda.gov/fsp/rules/Legislation/history.htm