In Sickness and in Health: Health Insurance in America

A curious and revealing symmetry has developed between Republican and Democratic approaches to the issue of private health insurance. In the 2004 election campaign, John Kerry proposed that the federal government clamp a lid on premiums by relieving insurers of most of the expense for catastrophic claims—those that exceed thirty to fifty thousand dollars annually for any given individual. Democrats, in other words, identified themselves with the idea that those who are richest—those who contribute proportionately more to the federal treasury via the progressive tax base—should heavily defray the medical expenses of those who are sickest. For their part, George W. Bush and the Republicans have for some time pointed to the tendency for hospitals and health maintenance organizations (HMOs) to take money saved from premiums paid by their healthier clients—that is, patients who don't need much medical care—and use it to subsidize the expenses of the poor. This propensity, Republicans like to say, functions more effectively as a safety net than anything government could do.