National Health: Time for Squabbling to End


November 15, 1991|By ERNEST B. FURGURSON

WASHINGTON. — Washington -- If in our country a criminal has a right to a lawyer, surely the sick have a right to a doctor.

That's what Harris Wofford said in his winning senatorial campaign in Pennsylvania, and a lot of people are echoing him from coast to coast. It sounded natural coming from Mr. Wofford, an old New Frontiersman and Great Society Democrat. It could easily have been lifted from the stump speeches of Lyndon Johnson, as he campaigned on behalf of ''Mollie and the babies'' in the Sixties.

It reminds me, indeed, of the day Johnson ended the long fight for Medicare by signing it into law at Harry Truman's side in Independence, Missouri. Afterward, the expert who had shaped that insurance program was exultant.

He was Wilbur Cohen, former secretary of Health, Education and Welfare. Passage of Medicare and Medicaid, he said, meant that ''The long ideological dispute in this country over national health insurance no longer is whether every American should be protected by comprehensive coverage, but how or when.''

Extremely gradually, the 26 years since then have proved him right.

In 1974, Republican Richard Nixon offered a substantial health-insurance plan, but it did not pass against the opposition of the American Medical Association and more conservative politicians. There have been sporadic efforts since. Last spring, even the Journal of the AMA recognized the plight of public health in America and came out for some form of nationwide coverage.

Current opinion polls say more than half of U.S. citizens believe there should be either mandatory coverage by employers or a national insurance system. This week, a coalition of labor unions, big business and two former presidents, Republican and Democratic, actually agreed on how to do it.

As Mr. Cohen said at mid-point of the Great Society, the long ideological dispute over ''whether'' has faded. Only a few right-wingers and libertarian holdouts object to having comprehensive coverage. But the dispute is not ended. Now, as then, the debate is over how and when.

The long-standing scandal of tens of millions of Americans not covered by any health plan, of working Americans bankrupted ** by what they have to pay for treatment or coverage, is well known. It affects not only the jobless and poverty-stricken, but families at every level of society.

The emerging scandal is not those familiar facts, but the refusal of politicians to agree on a cure.

That particularly applies to Democrats in Congress and the 1992 presidential race. Their party produced Social Security, Medicaid and Medicare, among dozens of other social programs that even hidebound Republicans do not dare to criticize today. It is the Democrats' duty -- and their political opportunity -- to take the lead on health care now by agreeing on a plan that has a realistic chance of passage.

There are about 30 different plans bouncing around on Capitol Hill. The sponsors of most of them sincerely believe their approach is best. But as long as there are 30, none has a chance of becoming law.

If the Chrysler Corporation, Georgia-Pacific, Safeway, Westinghouse, Xerox, Bethlehem Steel, Jimmy Carter, Gerald Ford and a list of other companies, trade unions, teachers and nurses organizations can agree on one version, surely the Democrats can, too.

Those institutions sat down together as the National Leadership Coalition for Health Care Reform, and announced their support this week for the ''play-or-pay'' plan supported by key congressional Democrats. Under it, all employers would have to provide health coverage or pay a 7 percent payroll tax to help finance insurance for their workers and the jobless. Employees would pay a 1.75 percent tax.

Is this approach perfect? Hardly. Small businesses, which now provide least coverage, object that it would hurt them most. Secretary Louis Sullivan, speaking for the Bush administration, naturally expresses reservations. The administration has been ''studying'' the situation ever since Mr. Bush was sworn in.

The AFL-CIO prefers a more sweeping, Canadian-style national health-insurance program. But its convention just agreed to support ''play-or-pay'' as a first step in that direction.

Congressional Democrats should call a party caucus at which their competing plans are voted on and eliminated one by one, until a single version emerges. Then all should pitch in behind that plan.

With such a clear approach, their party would have a powerful and positive issue to balance its criticism of the president next year. With more squabbling and indecision, they will deserve what they get.

Ernest B. Furgurson is associate editor of The Sun.

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