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I Hate Universal Health Care. Except That I Don't.

Today's Atlanta Journal-Constitution carries an op-ed on health care that is positively infuriating--but also, in one sense, encouraging.

First, the infuriating part.

The op-ed's title is "Fix America's health care system--the capitalist way." Its author is Joe Rogers, CEO of Waffle House, and he begins by describing the health insurance his company makes available to workers--an offer, to his dismay, many employees turn down:

At Waffle House Inc., we have, for over 25 years, offered affordable group medical insurance to our hourly and management associates with the company paying 50 percent of the premium. But even with this, only about one-third of those who could enroll do so. Others decide to use their money differently for whatever reasons and take the risk of going uninsured. 

Maybe I'm reading too much into this, but the implication here seems to be that the problem of the uninsured is largely the fault of ... the uninsured. 

It's a pretty common sentiment, both on the right and in the corporate community. It's also pretty misleading. Many of the uninsured don't have access to policies that are both reasonably priced and provide adequate coverage. Among those who do, many simply can't spare the money without giving up other major necessities. (A few clicks below, my colleague Suzy Khimm has more on this.) 

Equally maddening is Rogers' hasty dismissal, not just of any health care plan on the agenda but every health care plan on the agenda:

None of the present ideas around health care will do anything but add complexity and cost and there is already enough of that. 

To be sure, there are some people--my friends at the Cato Institute, for example--who sincerely believe that. But Rogers isn't one of them. And I know this because, having written off the entire health care agenda, he proceeds to lay out his own ideal version of health care reform:

The answer is to create a new currency that can only be used for health care. Have the Internal Revenue Service issue coupon books to individuals and families, with the coupons redeemable monthly, for a basic medical insurance policy from an insurance company or allow a medical provider such as a full-service hospital system to take the coupon directly. The basic plan would provide for a deductible, then an 80-20 co-pay, similar to many group policies. An insurance company or medical provider could offer more benefits if you wanted to put cash in the monthly envelope along with the coupon.

The IRS would administer the program, determine the coupon value for different regions of the country, redeem the coupons and allocate the cost back to the taxpayers with some paying nothing and others, like me, paying a multiple of my value. Corporate America would be glad to pay to the IRS what it is now paying out in health care costs through some additional payroll tax. You could cancel Medicare and Medicaid and cover everyone with one system.

Any of this sound familiar? Rogers has just described the basic building blocks of a universal health care voucher system--one that, in its overall design, is not that far removed from what Obama advisor Ezekiel Emanuel has described in his book Healthcare Guaranteed and what Senator Ron Wyden has proposed in his bipartisan universal coverage bill.

Such programs are sometimes tough to enact politically. Among other things, they generally require a requirement that everybody buy insurance--since, in fact, at least some people really do choose not to buy insurance when they could. But this doesn't seem to bother Rogers, either, who embraces such a mandate and cites the success of iconic liberal programs as justification.

People don’t always make good long-term choices. That’s the reason Social Security was set up and has proven to be successful (forget the management of it and look at the customer). Food stamps similarly have been an effective safety net. (What if Medicare did not exist?)

It seems Rogers isn't nearly as hostile to the philosophy of universal health care as he is to its present packaging and, perhaps, its packagers. And while that doesn't mean he--or any of his counterparts--are going to become cheerleaders for reform, it's a useful reminder that blustery conservative rhetoric on health care sometimes masks views many reformers share.

--Jonathan Cohn

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