IN 1993, President Clinton proposed a plan for universal health insurance. In beating it back, opponents smoothly assured the public that they supported the idea in principle, they just wanted to package it in a better way.
Here's what you get for listening to smoothies:
No serious interest anymore in guaranteeing all Americans access to medical care. A congressional majority -- mostly Republicans but including some Democrats -- strangled the Clinton plan, then walked away.
A proposal for gradually raising the Medicare age to 67. That would push many future retirees, 65 to 66, into the ranks of the uninsured.
Most older people today don't remember what it was like pre-Medicare, when health insurance was available to only a very few. When you "go bare," you risk your health, even your life.
Loss of Medicaid benefits for people removed from the welfare rolls. Among women, only one-third get private insurance when they leave the rolls, says Pamela Farley Short, a professor at Pennsylvania State University. The rest get Medicaid for a short while. After that, tough luck.
More of the nation's 11 million uninsured children will be covered under Clinton's program for children's health insurance, passed in 1997. But most of the growth in the uninsured has been among adults. About half the uninsured work for smaller companies, says Paul Fronstin of the Employee Benefit Research Institute in Washington.
You're also vulnerable if you're forced into early retirement (a declining proportion of firms offer coverage to their retirees) or if you're self-employed. If you have any sort of health condition, insurers might not cover you at affordable rates.
"Almost everyone we see has a story which illustrates, sometimes tragically, the plight of the uninsured," says Dr. Robert LeBow of the Terry Reilly Health Center, a community clinic in Nampa, Idaho.
"We're talking dead mothers because they couldn't afford prenatal care, or diabetes wildly out of control, for lack of simple medications," he says.
For this, Ira Magaziner harbors many regrets. He was the chief architect of the Clinton plan, and thinks that -- with some luck and better political management -- a version would have passed. Financially, Magaziner saw a window of opportunity. The growth in health-care costs was projected to decline. Some of the savings could have been applied to universal care.
As it turned out, health-care inflation slowed more than Magaziner expected -- from 9 percent in 1990 to 2.8 percent in 1997 (with a small increase in 1998).
The savings flowed through to corporate profits, deficit reduction and slower gains in health-insurance premiums -- all good things, but with nothing left for the uninsured.
Unfortunately, the forecast is for rising numbers of uninsured. All sorts of little bills in Congress would try to plug this or that small hole. But nothing seems to have majority support, and no bill would create a true medical safety net. What might put universal care back on the table? Maybe Congress would get interested if the uninsured reached a critical mass, as they might in a bad recession when people are losing jobs. But that's a pretty high price to pay.
And even a recession probably wouldn't be enough. Members of Congress care the most about being re-elected. Health insurers can often bring them to heel by threatening to support an opponent in the primary or blitz the district with negative ads.
No rich political action committee supports the uninsured. To overcome Big Money's heavy hand, public support for universal care would have to be intense. Any plan for universal care would also need the backing of the big corporations that pay the majority of medical bills today. Corporations lost interest in reform in the mid-1990s, when their own costs of insurance fell. But now their costs are heading up again.
Employer medical costs jumped an average of 6.1 percent last year, as measured by the consulting firm William M. Mercer. This year's projection is 9 percent.
Revamping America's health care system from the ground up could slash employers' costs. It could shrink the wasteful overhead found in insurance company bureaucracies.
But employers would also want the government to pick up some of their employees' medical costs. That, plus the cost of expanded care, would require federal funds. With Social Security, Medicare and tax cuts all on the front burner, the uninsured haven't got a chance.
Every other developed country offers universal care. We'll get there someday, but a lot of suffering will go down first.
Pub Date: 4/05/99