What does "universal health care" mean anyway?

On the 18 July 2008 broadcast of On The Media, Trudy Lieberman discusses how the press has done a poor job covering the politics and language of healthcare. In particular, she addresses one of the key misconceptions I've heard quite a bit; namely, that when Barack Obama speaks about "national" or "universal" healthcare, he really isn't talking about creating a system like the National Health Service in the UK. Instead,

TRUDY LIEBERMAN: Essentially, what Obama would like to do is craft a plan that builds on private insurance coverage from Aetna, Cigna, Blue Cross and the like, and add to that a public program, a national insurance exchange people might be able to go to and buy coverage. If this entity, this health insurance exchange works, then people will have another option.

Let me say what the lead of an AP story was that I think came very close to describing what Obama is doing; that Obama was proposing universal access to coverage. Access is the key word, as opposed to automatic coverage as a matter of right.

Indeed, in her posting "One Step Forward, One Step Back" on the Columbia Journalism Review blog, Lieberman notes that Obama's position "leaves unanswered the knotty question of whether people will actually be compelled to buy a policy. If they will not, it’s hard to figure where the universality comes in."

Not that McCain's plan is much better:

TRUDY LIEBERMAN: Basically, McCain wants you to pay taxes on the employer provided insurance that you get. And when that happens, he’s going to give tax credits to people, 5,000 dollars for families, 2,500 dollars for individuals, to go into the individual market to buy their own coverage.

It’s likely young, healthy people will leave the employer plan and go into this individual market, leaving only the sick people left in the boss’ insurance, and that will send the premiums through the roof.

What this will do eventually is force a large crack in the employer provided insurance market, and ultimately, people will have to go to the individual market to buy their coverage.

Both the CJR post and the On The Media segment are worth reading/listening to.