This week, Senator Ron Wyden (D-Oregon) announced a bill, entitled The Healthy Americans Act, that seeks to eliminate the blight of the uninsured in America. Of the many piecemeal or hopeless pieces of health care reform legislation that litter the political landscape, this one really gets me excited because it’s comprehensive, well-conceived, and most importantly, realistic. You can read about it on his website, but I’ll summarize some of the key ideas here.

The Health Americans Act is based around an individual mandate that requires all citizens to have health insurance. As the system currently exists, an individual mandate isn’t workable because citizens who don’t receive benefits through their employer are left to fend for themselves on the individual market, where insurers do everything in their power to either deny applicants outright or price them out of the market. Thus, any legislation proposing an individual mandate must do things to make health insurance more affordable.

The first step the bill would take is to finally sever the link between health insurance and employment. It does this by forcing employers to convert the money they previously spent on health care premiums to an immediate wage increase for workers, which they could then use to purchase health insurance on the individual market. Businesses win because they’re instantly shielded from the double digit annual growth in premiums in recent years. Employees win because for those who were receiving benefits, they should either break even or come out ahead.

People who can’t afford to buy insurance will be helped in a number of ways. The bill stipulates that all health insurance plans must be community rated, allowing price to vary only by geographic location and level of coverage. This means that everyone pays the same amount for the same amount of coverage. Presently, people perceived as “high risk” by insurance companies face outrageously high and unaffordable premiums. Community rating increases the size of the risk pool and ensures that everyone has access to affordable coverage. All plans must meet a minimum basic level of coverage, and those who wish or can afford to can purchase supplemental insurance.

The cost of insurance will be 100% paid for individuals and families below the poverty level. Subsidies will also be provided on a sliding scale up to 400% of the poverty level.

One provision I really like is that co-pays are prohibited for all preventive care and primary care physicians visits. Co-pays are a nasty tool employed by insurance companies to cut costs and fight moral hazard (the claim that people with good insurance are insensitive to costs and will therefore engage in risky behavior), even though there is precious little evidence that co-pays accomplish either. In fact, they usually serve as nothing more than a huge cost barrier to people on a budget. Eliminating co-pays should lead to better utilization of preventive care, reducing costs in the long run.

There’s more to the plan, and I encourage you to read all about it, but those are the main points. I’d love to be idealistic and wax poetic about single-payer health care with government acting as the insurer, but this plan is as good as health care reform is going to get in America for now. It ends employer-based insurance, virtually guarantees universal coverage, will help contain costs, and preserves the insurance industry. It’s not perfect, but it gets the job done. So let’s not let this get swept under the rug, eh?

- Zach Shoup