Il meccanismo proposto non e' una novita' assoluta (si tratta del cosiddetto "individual mandate", simile alle nostre vecchie mutue), ma per la prima volta il Governatore potrebbe riuscire a superare gli ostacoli posti da destra e da sinistra. E tutto questo, scommette, senza aumentare (troppo) i costi per la comunita'.
L'idea e' quella di rendere obbligatoria la copertura assicurativa, esattamente come nel caso della RC auto.
I premi pagati e l'erogazione delle prestazioni resterebbero gestiti da organizzazioni private in concorrenza fra loro, ma lo stato del Massachussets sussidierebbe i premi per le famiglie piu' povere, impiegando i soldi che al momento spende per pagare i conti delle cure di emergenza.
Direi che si tratta di un piano che qualsiasi assessore regionale alla Sanita' in possesso del raziocinio e di un po' di coraggio potrebbe prendere di peso e trasportare da noi....
Here is how it would work. Massachusetts now spends about $1 billion a year to provide emergency health care for at least 500,000 uninsured citizens. About 200,000 of those are young people, predominantly male, who are making enough money to buy health insurance but figure they don't need it. They would be required to buy a relatively inexpensive health insurance policy, with higher deductibles and co-pays—that's where the "mandate" comes in. Another 100,000 are extremely poor people who are eligible for Medicaid; a concerted effort would be made to bring them into the system. The remaining 200,000 are the people who have been most neglected by the system in the past: the working poor, people who have low-end service jobs or work part time for employers who don't offer health coverage.
Romney's gamble is that Massachusetts can take the $1 billion it spends on the uninsured and use it to subsidize coverage for the working poor. The Bush Administration will kick in another $1 billion, over three years, to make the experiment work if Romney can get a suitable proposal through his state legislature. "Our plan would cost the poorest eligible families only about $2 per week in premiums," Romney said. "The more you earn, the more you pay." Sounds simple enough. So why hasn't it been tried before? Because interest groups on the left and right hate the idea. Conservatives don't like the mandatory part: if a 28-year-old software designer doesn't want to buy health insurance, why should the government force him to do so? Simple answer: fairness. The rest of us pay for it now when he drives his motorcycle into a tree and runs up a huge medical bill. Health insurance should be no different from auto insurance, a basic civic responsibility. There's also a larger argument for the common good: the more healthy young people are paying into the system, the lower the premiums for everyone else. But Democrats, skittish since the Clinton proposal was trashed in 1994, have refused to call for an individual mandate.
On the left, activists dislike an individual-mandate system because it relies on the ability of poor people to navigate the complexities and uncertainties of the free market. Some favor a government-funded system like those used in Canada and Europe.
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