The dream of universal healthcare, as outlined so far in the Democratic presidential race, looks like this to me: Every American (says John Edwards) gets health insurance or at least most people (says Barack Obama). Will it mean higher government spending? Probably. But it can be paid for via higher taxes on wealthy Americans (Edwards). But who knows, maybe through greater use of technology, cost savings will be enough to avoid a tax increase (Hillary Clinton).
But as the various plans get looked over, explained, and debated, it seems very likely that all sorts of unanticipated aspects to them will pop up, such as this recent piece of insight from Edwards regarding his plan, via an AP story:
"It requires that everybody be covered. It requires that everybody get preventive care," he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. "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."
Certainly at first glance, Edwards seems to be advocating a system where you get health insurance only if you follow certain government-prescribed healthcare routines, like regular doctor visits. Now after re-examining the Edwards plan, liberal blogger Ezra Klein concludes that patients "will have incentives to avail themselves of preventive options. But there won't be any mandate for X doctor's visits every Y years." Maybe he's right. But then again, maybe Edwards was accidentally describing the future of any government-directed healthcare system. Just look at Great Britain. That nation's national health system already demands that obese patients lose weight before receiving hip replacements. But the out-of-power Tory Party wants to go further, according to London's Evening Standard (via the Drudge Report):
Failing to follow a healthy lifestyle could lead to free NHS treatment being denied under the Tory plans. Patients would be handed "NHS Health Miles Cards" allowing them to earn reward points for losing weight, giving up smoking, receiving immunisations or attending regular health screenings.... But heavy smokers, the obese and binge drinkers who were a drain on the NHS could be denied some routine treatments such as hip replacements until they cleaned up their act.... Those who abused the system—by calling an ambulance when a trip to the GP would be sufficient, or telephoning out of hours with needless queries—could also be penalized.... Yet while the Health Miles Card would award points for giving up smoking and losing weight, it could penalise those who are already fit and well because they would receive no benefits under the scheme.