The Road to Totalitarianism?

Lots of claims are being made about John Edwards’ apparent endorsement of “mandatory preventive care” in a speech. First, let’s look at his exact language:

[Edwards said his universal health care proposal] “requires that everybody be covered. It requires that everybody get preventive care. . . If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”

Now, if I understand the Edwards health plan correctly, that “If you are going to be in the system” qualifier is very important. Note this cornerstone of his proposal:

Health Care Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price.

The key question here is: what did Edwards mean by “in the system”? If he meant “part of the backstop ‘Medicare for All’ program, I don’t see how his policies significantly differ from ones already endorsed by the Bush administration. Moreover, given that they are designed to extend health care to the now uninsured, wouldn’t the uninsured be better off with a new option for care–even if such strings were attached?

Edwards’ plan for “Health Care Markets” mirrors something the critics of universal coverage never seem to mention–that other systems that do offer universal coverage also routinely let their citizens supplement the state-run program with private insurance. Consider the case of France, detailed in Paul Dutton’s Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France:

The French share Americans’ distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as “socialized medicine.” . . . French legislators also overcame insurance industry resistance by permitting the nation’s already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by Sécurité Sociale. Indeed, nearly 90 percent of the French population possesses such coverage, making France home to a booming private health insurance market.

Let’s just say this doesn’t sound like totalitarianism to me.

Now, if Edwards really meant mandatory preventive care for everyone, sure, that is a big change and worth debating. But anyone who’s panicking about it might also want to worry about this bottom-line demand from the former Senator: “Does your plan cover every single American?”

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