GRAY MATTERS    Newsday.com

Health care: The best won't be the easiest

Saul Friedman
Family & Relationships

April 21, 2007

As we've discussed, "Medicare for All" may seem the simplest and most logical path to universal health care. But the nation's conservative traditions and the entrenched multizillion-dollar for-profit health care establishment will be formidable obstacles on that path.

It took 20 years of political struggle to get Medicare, and it passed only because an overwhelmingly elected Democratic president, Lyndon Johnson, had veto-proof majorities in both houses of Congress. Such one-party control is not the case now, nor will it be after 2008, unless there is a political earthquake.

Thus, any proposal for universal health care will have to reckon with the combined power of the nation's richest and most powerful lobbies - the insurance industry and drug manufacturers, as well as medical professionals who make out well in the current system. People are easily fooled by misleading ads. Remember the insurance lobby's "Harry and Louise"?

My mail shows that while most Americans say they favor publicly supported universal health care and social insurance, including Medicare and Social Security, a vocal minority strongly believes that would lead to socialism or worse. The minority will be aided by a network of right-wing think tanks that never supported Medicare but helped kill the Clinton plan in 1994.

Every Democratic presidential candidate favors one form or another of universal health care. Along with several Republican governors, they have proposed what they believe is a more politically palatable path than Medicare for All - a combination of public and private health insurance. They would mandate that individuals buy insurance and, if necessary, raise revenues to subsidize those purchases.

Most of the more pragmatic proposals reject the single-payer approach, fearing it would run afoul of lobbying campaigns against centralized government control of health care. The latest proposal, called AmeriCare, comes from one of the most liberal members of Congress, Rep. Pete Stark (D-Calif.). Like most others, it would depend on private, for-profit insurance companies to provide health care for the non-elderly.

Even AARP, which earned $379 million in royalties in 2005, mostly from health insurance sales, appears to favor universal public and private health care coverage. AARP endorsed and makes millions from Part D, which is based wholly on private coverage. Last month's AARP Bulletin reported on various state schemes for universal private coverage, but made only passing mention of the Medicare for All proposals in Congress.

The most comprehensive public-private proposal favored by some liberal groups has come from Yale political scientist Jacob S. Hacker. Writing for the liberal Economic Policy Institute, Hacker said he seeks "to avoid the dismal fate of previous reform campaigns" that ran afoul of budget problems, public resistance to change and "the embedded realities of the present system."

His proposal, Health Care for America, would "extend insurance to all non-elderly Americans through a new Medicare-like program and workplace health insurance.... Every legal resident of the U.S. who lacks access to Medicare or good workplace coverage would be able to buy into the 'Health Care for America Plan,' a new public insurance pool modeled after Medicare....Employers would be asked to either provide coverage as good as this new plan or make a relatively modest payroll-based contribution to Health Care for America.

"It would not eliminate private employment-based insurance....It is not single-payer - a vision that, for both political and budgetary reasons, is unlikely to be achieved in the near future. Nonetheless, Health Care for America does embody many of the key virtues of a universal Medicare-like program."

Hacker's plan would put private insurance in competition with a Medicare-type plan to provide coverage that would be guaranteed. "Health Care for America," he writes, would provide "a generous package of benefits...greater choice." (See epi.org for the full text of Hacker's proposal.)

Diane Archer, former president of the New York-based Medicare Rights Center, applauded the proposal as a way to create competition between public and private insurers, and predicted that for-profit insurers would not compete because "they would still try as hard as possible to avoid insuring the people with the costliest conditions."

President George W. Bush, who opposes government involvement in health care, says universal coverage should be provided only by private insurers. Under his recent proposal, government would grant people more tax incentives - greater deductions - to buy health insurance, perhaps through their employers.

But many of the 45 million workers who are uninsured don't pay enough taxes to benefit from any deductions. Many cannot afford insurance for themselves and their families, and others can't qualify because of adverse medical histories.

While the president opposes government health insurance for others, he and his immediate family, including his mother and father, have benefitted most of their lives from government-supplied, taxpayer supported health insurance. And they'll never be without that coverage. They (as well as Vice President Dick Cheney and members of Congress) earned it with government service. If government coverage is good enough for them, what about the rest of us?

The most cogent criticism of the plans offered by Hacker and several governors came in an editorial by the Des Moines Register. It said that requiring the purchase of health insurance, called "individual mandates," through employers or subsidies, "is far from simple, especially considering the government absolutely must ensure the coverage it makes people buy is adequate."

Noting that a Register reader who bought an AARP-endorsed plan for $700 a month ended up with $200,000 in bills when he was treated for cancer, the editorial said, "Our greatest concern is that an individual mandate moves this country in the wrong direction by relying too heavily on the private sector to achieve universal coverage."

Copyright 2007 Newsday Inc.