Top agenda: health care reform
In the past 14 years, the need for comprehensive health care reform has become ever more compelling. As the National Coalition on Health Care reported last month, the number of uninsured Americans is expected to rise from at least 45 million now to 51 million by 2006.
Health care costs are rising at double-digit rates, putting a drag on economic growth by raising insurance rates, cutting into corporate investment and profit, and consuming more of the disposable income of workers and retirees.
And despite growing attention being paid to the problem of poor quality in health care, NCHC’s president, Henry Simmons, cites estimates that medical errors rank as the third leading cause of death in America, just behind cancer and heart disease.
NCHC, consisting of 95 of the nation’s largest businesses, unions, pension plans, nonprofits, churches and medical groups, released a new study showing that any of four models of comprehensive reform could save the nation hundreds of billions of dollars over a 10-year period, as well as improve quality and reduce the ranks of the uninsured to zero.
In 1991, Sen. Harris Wofford (D-Pa.) gained political traction by pointing out that since the Constitution guarantees all criminal defendants a lawyer, the United States should also guarantee the right of sick people to see a doctor.
Wofford joked that he recently learned from Harvard President Larry Summers that his 1991 success also attracted the notice of Cuban dictator Fidel Castro, who told Summers, then a World Bank official, that “maybe now America will get universal health coverage.”
The United States doesn’t have it yet — and the NCHC’s models show that the U.S. doesn’t have to resort to Cuban-style socialized medicine to get it.
The group’s options include: 1) a combined employer and individual mandate, 2) expansion of existing public programs such as Medicaid to cover segments of the uninsured, 3) creation of a new targeted government program, perhaps modeled on the Federal Employee Health Benefits Plan and 4) establishment of a new publicly financed system.
NCHC officials say that option 4, involving the largest initial government outlays and long-term savings, conceivably could allow for private insurance — though it might also resemble Canada’s government insurance system. It would not, however, resemble Britain’s (or Cuba’s) program, in which doctors are government employees.
As history shows, there certainly are political dangers in trying to enact wholesale reform of the U.S. health care system. The Clinton proposal, championed by then-first lady (now Sen.) Hillary Rodham Clinton (D-N.Y.) and backed by Wofford, was opposed by Republicans and the health insurance industry as too government-heavy and was defeated in a Democratic Congress.
Politically and on the merits, advocating comprehensive health reform should be a net benefit in 2006 — and 2008, too — probably more for a Democrat.
President Bush and GOP health experts such as Senate Majority Leader Bill Frist (Tenn.) are wedded to an incremental approach emphasizing tax breaks and legal changes that would enable individuals and small companies to buy their own insurance and pay attention to the costs.
So far, even though the NCHC includes such giant entities as General Electric, the AFL-CIO, AARP, several state pension systems and some big insurance companies, its models have yet to be converted into legislation — or even a stump speech.
Sen. John Kerry (D-Mass.) and Rep. Henry Waxman (D-Calif.) are sponsoring a plan to cover 11 million uninsured children, but that would be only a step toward comprehensive coverage.
If and when a politician goes all the way, there will be renewed controversy over costs, government control and an NCHC proposal for “containment” of insurance premiums, which might be labeled “price controls.”
Still, the problem is real. It’s time that health care reform is seriously debated again. And an election campaign is a good place to do it.
(Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.)