The health care debate reopens
With health costs surging and the ranks of the uninsured swelling, Sens. Edward Kennedy (D-Mass.) and John Breaux (D-La.) are pushing for a new look at comprehensive health care reform.
Kennedy, the old lion liberal, has given up on his dream of a Canadian-style, government-run health insurance system and shortly will introduce legislation mandating that every employer except the smallest provide a basic insurance plan for its workers.
Breaux, who defines himself as a “radical centrist,” is working on perhaps his most radical health reform yet — replacing the nation’s current employer-based insurance system with an individual mandate.
The two Democrats are moving in opposite directions from a policy standpoint, but they are acting on the same assumption — that rocketing costs and collapsing coverage are putting the health care system into crisis.
Ten years ago, a similar perception led the Clinton administration to propose replacing private insurance companies with government-managed HMOs — a plan that crashed and burned politically but may have suppressed health costs and premium increases temporarily.
During those 10 years, the federal government has put in place a number of incremental reforms — Kennedy has been a chief sponsor of insurance portability and expansion of Medicaid for poor children and the disabled — but the string may have run out on incrementalism.
“All the problems that made action so urgent then are back now — accelerating growth of the uninsured, double-digit health care cost inflation, a new sense of insecurity even among Americans who have health insurance,” Kennedy said in an interview.
His list went on: “Emergency rooms bursting at the seams, a nursing shortage and the threatened quality of care, physicians forced to spend less time with patients … and the government imposing arbitrary cutbacks to hard-pressed hospitals and physicians.”
Indeed, the latest survey by the Kaiser Family Foundation showed that employers are facing insurance increases this year of 12.7 percent, the largest since 1990. The Census Bureau is expected to report soon that the number of uninsured persons has once again risen above 40 million.
The looming crisis has swelled corporate, union and pension fund membership in the National Coalition on Health Care, a group dedicated to promoting comprehensive health care reform, improving quality of care and containing costs.
According to the coalition’s president, Henry Simmons, “The difference between now and 10 years ago is that a lot of important constituents have been persuaded that the present system is unsustainable.”
New members of his group include the Motion Picture Association of America, the Alliance of TV and Movie Producers, the California state pension system and the New York State Teachers Pension Fund, plus firms such as Chrysler, AT&T and the AFL-CIO.
Even though there’s a growing consensus on the immensity of the problem, there’s vast disagreement on how to solve it. When Kennedy first proposed his employer mandate this summer, an eruption went up from business groups, which predicted it would cause bankruptcies and lost jobs.
No cost figure has been worked up for the plan, but Kennedy notes that savings can be achieved by reducing administrative and paperwork inefficiencies in the health system, which account for $400 million of $1.4 trillion total annual outlays.
While Kennedy’s plan has the advantage of building on the employer system that’s dominated health care since World War II, Breaux’s would end that system. He’s even thinking about collapsing Medicare, Medicaid, veterans health and other government programs into a single national insurance plan.
People would be required to have a basic health plan much as they do auto insurance, with better coverage optional and subsidies for the poor. Kennedy thinks it will take a 2004 presidential candidate to put health reform back at the top of the nation’s agenda. Breaux is skeptical. “When you’re campaigning for president, you tend to look for sound bites. This is not a sound bite. It’s a whole chapter.” But it’s coming. It has to.
(Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.)