Los Angeles

EVERYONE who wants universal health coverage (me included) finds irresistible the rallying cry that all Americans should have the same health benefits that members of Congress have. But Congress’s health insurance  that is, the heavily subsidized preferred provider plan that most members have  is not an ideal model, because it is quite rich. As with other fee-for-service plans, it does little to encourage people to be smart health care shoppers.

Congress’s health plan pays for routine expenses like office visits and vaccinations, for example, which is like auto insurance covering oil changes or new windshield wipers. As a result, the premiums are steep  upwards of $13,000 a year for a family (69 percent of which is paid by the government). To provide the 50 million Americans who are now uninsured with such a plan would require scary tax increases.

When faced with staggering cost projections, advocates of universal coverage often suggest something less grand for the uninsured; after all, it’s better than the nothing they have now. But that approach violates the as-good-as-what-Congress-has standard. Plus, it makes uncomfortably explicit the dread possibility of a “two-tier” system in which influential or better-off Americans have lavish health insurance, and the less affluent make do with a slimmed-down plan. (To be sure, we now have multiple-tier care, but in a democracy we like to pretend that’s not the case.)

The obvious answer  conveniently overlooked by the 535 well-insured members of Congress  is to stick with our rallying cry, but give Congress a more cost-effective plan.