Universal healthcare not as scary as it seems

Gut instinct always used to tell me that America would never go for universal healthcare coverage. In the back of my mind, I kept picturing either a healthcare free-for-all with everyone and their uncle running to the doctor for every little paper cut, or just as bad, everyone and their uncle waiting in line for months to receive their ration of healthcare. You might have envisioned those alarming circumstances, too.

2006 might be seen as the year that the first attempts at universal healthcare coverage began, or depending on how you define it, perhaps the first attempts at cooperative, large-scale coverage for the uninsured.

You could think of the Massachusetts reform like a somewhat pricey department store converting into a big shopping mall with a variety of stores offering merchandise at various price points. If you can afford the name-brand athletic cross-trainers, great. If not, you can get a subsidy to at least buy a decent pair of canvas tennis shoes. Legislators expect that nobody will have to walk around barefoot in Massachusetts ever again.

Just last month in California, San Francisco Supervisor Tom Ammiano was all hugs and handshakes as the board voted unanimously to adopt the San Francisco Health Care Security ordinance. While it's not universal insurance coverage, San Francisco's plan does expand access to public health clinics and include preventive and primary care in the city for all its residents who otherwise have no health coverage.

San Francisco's medium-sized business owners reportedly are bristling at this reform. It obligates them to contribute either with direct funding to the Health Access Program or by offering their employees insurance or health savings accounts that meet minimum requirements. According to early reports, the direct funding contributions could start at about $45,000 annually for a company with 20 employees.

A business owner that already provides good health benefits to employees might see this reform as one that levels the playing field. No longer will a benefit-providing business be at an economic disadvantage compared with the business down the street that doesn't offer benefits (15% in San Francisco don't). Of course, as some observers predict, the no-benefit company just might move out of the city and avoid the obligation altogether.

However, the next city over, or the state of California, or the entire West Coast could design a universal coverage or access plan. Move your business all you want, the obligation might follow you anyway.

Truth is, one way or another, we're all paying for the care of America. Whether it's through higher premiums for the insured, higher taxes or higher costs of goods and services, we're all footing the bill.

I'm warming up to the idea of universal coverage. The vision of runaway or rationed care is fading. There are still the hurdles of legal challenges and practical implementation to overcome, but universal healthcare is taking shape.

Julie Miller can be reached at julie.miller@advanstar.com