It's virtually a given these days that the uppermost personal concern of the vast majority of Americans, other than the obvious one of earning a regular paycheck, is affordable health care. Only the wealthiest can escape the haunting fear that a single family illness, even a common one like cancer, can in a matter of weeks turn relative economic security into a life doomed to penury.
In retrospect it's easy to see what happened: Thirty years ago, a tacit compact was reached that government would pay for the health care of the poor (through Medicaid) and the elderly (through Medicare) while the private sector would pay for the care of the working middle class (through group health insurance). Then runaway inflation struck health-care costs with a vengeance, and now everyone -- business and industry, the health care profession and the general public alike -- recognizes that the compact is in shambles.
And yet there remains a total void of leadership at the presidential level when it comes to solutions to this fundamental human need. All we get from the White House is a promise that President Bush will reveal his health care proposal before the 1992 election. It's becoming, frankly, a little reminiscent of Richard Nixon's 1968 secret plan to end the Vietnam War.
Although it is not the desirable solution, it is inevitable that the states are devising plans of their own, and two promising proposals have emerged in the past 10 days in Maryland.
The first came from Blue Cross and Blue Shield of Maryland, the dominant player in the private health-insurance field, which unveiled something called CorePlan One. This might be called the Volkswagen of health insurance -- a no-frills basic package designed to place minimum-benefits health-care insurance within the economic reach of the 570,000 Marylanders who are not now covered by group insurance plans and yet who do not qualify for Medicaid.
This is a welcome proposal, to be sure, but in the end it is an answer which seems to beg the question. The reason: The policy would cost an estimated $261 a month for a family of four, and that's simply beyond the reach of many if not most of the people it's intended to reach. Such a plan might pick up a few of those not presently covered, but no doubt the vast majority would remain in their present woeful predicament -- uninsured.
The second proposal comes from Sen. Paula Hollinger, D-Baltimore County, who is in the process of drafting legislation to create a system of universal health insurance for Maryland.
Ms. Hollinger's proposal is complex, but basically the idea is to create a fund sustained chiefly through employer contributions and payroll deductions, much the way private health-care plans are now funded. The amount of deduction required is not now known, but Ms. Hollinger feels it would be lower than the $261 estimate of Blue Cross.
This fund would pay for the same no-frills basic health care contained in the Blue Cross CorePlan One, except that it would be available to all Maryland citizens. The services would include the first 10 days of inpatient hospital or professional services; 10 office visits per year to a doctor, plus necessary laboratory work; reasonable obstetric care; emergency services; and other carefully defined health-care services.
A vital part of the proposal is that pre-existing illnesses would not be excluded, as is the case with most private health-care plans.
It's important to understand that Ms. Hollinger's basic plan would not pre-empt the role of private health insurance through company group plans. But such plans would simply add onto the basic coverage rather than supply the entirety of insurance needs as they presently do.
Equally important, the Hollinger plan would set up a mechanism, again supported by a payroll deduction, to pay for catastrophic illness not covered by the basic plan. No longer would anyone, even a reasonably well-off person, confront the prospect of having to be reduced to abject poverty before qualifying for Medicaid to pay for catastrophic illness.
The Blue Cross plan, while a good one, in the end is not the solution to the problem. The Hollinger plan, on the other hand, starts with the Blue Cross proposal and expands it to make it truly universal rather than merely closing part of the gap.
There is a great deal of refinement to be done on the Hollinger plan, to be sure, and there will be ample opportunity to do this in public hearings in the coming months. But at the moment it offers the best possible hope to address this major concern of people which is being totally ignored by George Bush as he concerns himself, between fishing and golfing, with such things as Baltic independence or Middle East peace conferences or most-favored-nation trading status for China.
Ray Jenkins is editor of the editorial pages of The Evening Sun.