By News producer
NBC News
updated 6/7/2005 12:07:18 PM ET 2005-06-07T16:07:18

Think back to a hypothetical middle-class family in the 1970’s. Dad probably worked in the same company most of his life. Healthcare benefits? Not an issue. The company could afford them, and dad and family were covered.       

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Fast-forward 30 years. Dad’s son is working for General Motors. But the company is struggling, says it will slash 25,000 jobs by 2008 , burdened by healthcare costs that take a $1,500 bite out of every car that leaves the assembly line.

And what about dad’s daughter? She is considering a job with a potentially lucrative start-up — but the small company cannot afford to pay its employees healthcare. She will just pray she does not get sick. 

Leif Wellington Haase, the author of  “A New Deal for Health: How to Cover Everyone and Get Medical Costs Under Control,”  a Century Foundation report, says though many Americans still get their insurance from their employers, “job-based health insurance is indeed collapsing in slow motion.”  

Healthcare should be 'citizen based'
In fact, it turns out that eight in 10 of America's uninsured are in working families, according to the Employee Benefit Research Institute.

“Middle-class families shouldn’t have healthcare based on the goodwill of their employers. Health care in this country should be citizen-based, not employment-based,” said Jacob Hacker, a political scientist at Yale University and author of the upcoming book, “The Great Risk Shift.” 

Arguing that healthcare cost should not drag down families and the economy, political scientists and analysts such as Hacker and Haase are advocating different plans to make healthcare something akin to car insurance.

Everyonemust have at least some basic, affordable insurance, regardless of one’s employment status or age.     

Gradual build-up
Hacker’s approach is to buildon the existing health insurance system and gradually work toward universal coverage.

One way to start, explained Hacker, is to allow companies to either provide their employees with basic insurance (a “Medicare Plus”) or pay a modest payroll-based contribution that is put into a “kitty” that funds public coverage. 

Americans who do not have Medicare or employer-based insurance can buy into the “Medicare Plus” plan by paying a premium based on their income level. And Hacker proposes that even folks on public coverage should be in an insurance pool that allows them to receive coverage from most providers around them. 

Hacker hopes his plan might be able to withstand the forces of what he calls “path dependency” that now characterizes health care. The idea that once something big is in place — even if it is not working well at all — it is hard to change it.     

Buy into one of three plans
Haase’s plan is more ambitious: he calls for phasing out the tax subsidies employers receive and for phasing out Medicaid and eventually Medicare. 

His wants the government to give every household a contribution used to purchase one of three national health insurance options — a basic, standard or luxury plan.  Every American has to buy into one of them or be automatically enrolled in the basic one.

Current insurance companies would be able to offer the three plans and compete with other insurers. Because it is “a network of structured choice,” most patients will not encounter the doctor restrictions that have been the bane of managed care.    

Both Hacker and Haase acknowledge their plans will be seen as politically unfeasible and too expensive to enact. 

However, experts warn that the increasingly competitive global marketplace, as well as demographics, makes the call for universal healthcare an economic necessity, not a liberal pipe dream.  

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