The following editorial appeared in Saturday’s Washington Post. In contrast with those of other advanced industrial democracies, especially in Europe, the U.S. system of social insurance and income support distributes benefits based not only on membership in society, but also on work effort, past and present. In the realm of health insurance, this means that instead of adopting universal coverage as a national legal standard, then devising a unitary system to meet that goal, the United States cobbled together programs whose organizing principle, such as it is, is work. A plurality of adults get tax-subsidized insurance through their employers; most retirees get Medicare, paid for out of deductions from their past paychecks. Many others – poor children, people with disabilities – obtain insurance from programs whose premise is that the recipients are neither expected nor able to work, which is itself a work-related criterion.
