All Full-Time Jobs Should Provide Health Coverage

The standard of American health care is probably the best in the world. Why? Because it’s mostly private rather then governmental, because our doctors are well trained and well rewarded, because we have devoted great resources to develop new technologies, medicines and procedures.

However, our private system has one central flaw. It is not available to everyone. Because our health care is so good, it is expensive. Most Americans only feel safe because their medical bills are paid through group health insurance provided by their employers. The government steps in only when there are typically no employers: Medicare for the elderly, and Medicaid for people in deep poverty.

About 85% of Americans are covered. But what about the rest--the 15% who aren’t insured? That’s 37 million people. If they get ill, they can be in trouble. They seek a charity ward or just forgo treatment. There is a hole in our social safety net.

Sen. Edward M. Kennedy (D-Mass.) has long been a champion of a broader, safer safety net. But in the past his remedy involved a greater governmental role. Opponents characterized it as “socialized medicine.” He never could get it enacted into law.

Now Kennedy has come up with a new way to skin a cat--about two-thirds of it, anyway. Twenty-four million of those 37 million uninsured are in families in which a member works full time. But their employers don’t provide group health coverage. Individual coverage is often prohibitively expensive. So Kennedy’s new bill would mandate that employers of these uninsured workers provide group insurance.

The approach goes with the flow of the new political and budgetary circumstance. It adds to the private, not the public, part of the medical system; there is no big-spending government program. Kennedy takes a non-ideological view of his shift from a public to a private plan. He says, “This can do the job. Let’s get the job done.”

The Kennedy proposal has other advantages: No one would need to stay on welfare just to get medical benefits. It takes a big step toward offering catastrophic health insurance for all. It should also have some allure for conservatives: They complain that an increase in the minimum wage ratchets up everyone else’s wages in order to retain existing wage intervals. The Kennedy plan is a “benefit,” not a “wage,” and would not generally have that effect.

Still, most conservatives oppose it. They don’t want government mandates. It could slightly increase unemployment. And they recite their mantra: “There is no free lunch.” In lunch terms they are correct. Most of the costs would be borne by the businesses involved, so costs would be passed along to the consumer.

But the question at issue, central to the debate about the safety-net state, is not whether we should provide entitlements, but which entitlements. Should we guarantee vacations overseas? Memberships in country clubs? No.

The safety-net state offers goods and services that society has come to see as necessities and not merely desires. Why? For reasons of humanitarianism and self-interest. It is humanitarian to say that we won’t let people go hungry. It is also selfish: We don’t like the sight of skeletal beggars. So we have welfare programs and food-stamp programs. Thus: As a society, relatively recently, we have come to believe that adequate nourishment is a human desire that is also a social necessity.

Health care is now crossing that desire-necessity threshold. The issue is not free lunch, but minimum lunch. There is too much that modern medicine can offer these days. Can we accept the idea that someone with curable cancer will not be able to afford the cure?

Kennedy’s bill is not perfect. It ought to be closely scrutinized in some of its important details. But its direction is sound. It goes a long way toward stitching up a big hole in the safety net.