Speaking at a health care forum at the New School in New York on Monday, October 29, the four senators and one congressman agreed that a change in the employer-sponsored health care system is needed, though they differed on the details.

All said increased openness in the price and quality of health care are necessary to reduce costs.

“We don’t have health care transparency,” said Sen. Bob Bennett, R-Utah. “So we don’t know who has the best quality and the lowest cost.”

The forum was titled “Reforming Healthcare: The Latest Solutions from the United States Congress,” though it was far from clear whether any proposals were either politically or economically feasible.

Republicans—echoing proposals by President Bush and presidential candidates Sen. John McCain of Arizona and former New York Mayor Rudy Giuliani—said offering tax deductions for individuals to purchase health insurance would eliminate a bias toward employer-sponsored health benefits.

Bennett and Sen. Ron Wyden, D-Oregon, said the Healthy Americans Act, a proposal they co-sponsored last year, is the first plan to sever ties between employment and health insurance. Employers would be forced to pay the amount they currently spend on health care as wage increases to workers. 

The plan would create regional health care pools from which people would be required to buy health insurance. Employers would not provide health insurance or manage it. They could make a regional health insurance product available to employees. But the tax deduction employers receive for providing health care would be eliminated.

“If you are in control of health care, you do not have to stay stuck in a job you hate,” Bennett said.

To which former Nebraska Sen. Bob Kerrey, president of the New School, later said, “I know employees who are only here because they need the health insurance.”
 
Tax deductions for individuals purchasing health insurance are a feature common to health plans proposed by Sens. Richard Burr, R-North Carolina, and Tom Coburn, R-Oklahoma, who also is a physician. Tax deductions could make it cheaper for employees to insure themselves rather than pay the premiums offered by an employer.

Burr’s plan, called the Every American Insured Health Act, gives Americans a flat tax refund of $2,160 for individuals and $5,400 for families, similar to the tax credit proposed by President Bush in his 2007 State of the Union address.

Burr said the tax credit would create a financial incentive for Americans to purchase the kind of coverage they need. With the aid of cost-and-quality information about health plans and doctors, Americans would have a financial incentive “to go out and negotiate coverage” that fits their medical budgetary needs.

Burr is also a co-sponsor of Coburn’s bill, the Health Care Choice Act of 2007. The plan introduces tax breaks for individuals purchasing health care and increases the taxes that can be deducted for contributions to health savings accounts.

Coburn said he opposes individual mandates that require people to buy health insurance, which have been used in Massachusetts and are compared to laws requiring drivers to carry auto insurance. Coburn said 15 percent of drivers don’t buy insurance despite the mandate.

“Mandates don’t work,” he said.

The plan by Rep. John Conyers Jr., D-Michigan, to create a single-payer government-run health care system drew the most enthusiastic response from the audience at the New School, which bills itself as a “progressive” university whose goal is “to prepare and inspire its 9,300 undergraduate and graduate students to bring actual, positive change to the world. “

The United States National Health Insurance Act would pay for a single-payer health care system with what Conyers calls a “modest” 3.3 percent payroll tax per employee. Employees and employers would pay a payroll tax of 1.45 percent. The wealthiest 5 percent of Americans would pay a “health income tax.”

Though Coburn said the taxes needed to fund such an entitlement program had been underestimated, Conyers said health care was a “human right,” and that the employer-based system was part of the problem.

Conyers said he wants to “take the profit motive out of health insurance and make it a human right.”

—Jeremy Smerd