Health care draws some unexpected teammates

July 07, 2002|By JAY HANCOCK

MARYLAND House Speaker Casper R. Taylor Jr. says he has always had "a love-hate relationship" with Maryland Business for Responsive Government, "and to this day I still do."

The sentiment once tipped more toward the hate. Pro-markets, anti-tax, Republican-oriented MBRG had a talent for getting under the fingernails of even moderate Democrats such as Taylor.

An Anglo-Saxon term for cattle manure issues from my telephone receiver when Taylor describes the tough scorecard MBRG keeps on legislators. "Pardon my French," he says, ever the gentleman.

But a few days ago Taylor was sharing the spotlight with Robert O.C. "Rocky" Worcester, MBRG's longtime president, to announce a blueprint for bringing health coverage to many of the 500,000 or so Marylanders who lack it.

For Taylor to use an MBRG-sponsored gig to unveil what might be the capstone of his long campaign to improve Maryland medicine is interesting. For Worcester to endorse his plan, which would significantly increase the size of government, is fascinating.

The convergence of the two men is telling us something about the future of health care in Maryland as well as the future of business-government relations.

First, the health care. A broad consensus seems to be forming on the necessity or inevitability of major medical-finance reform in Maryland.

Credit goes to Baltimore Health Commissioner Dr. Peter L. Beilenson, the Maryland Citizens Health Initiative and others who have pushed for universal care for all Marylanders. As the Beilenson plan gathered support, it prompted a statewide conversation on the uninsured and got others thinking about a less expensive, less extreme alternative.

The "single payer" universal system originally advocated by Beilenson would have been an economic earthquake, raising taxes on business, drawing patients seeking free care from other states and making Maryland a guinea pig for radical policy surgery. The Citizens Health Initiative has proffered an alternative plan, priced at about $1 billion, but many people still think it is too expensive, too ambitious.

Taylor's proposal, still sketchy but aimed at presenting Annapolis with legislation in January, would be more incremental, shifting resources from other areas, tapping federal funds and raising few if any taxes. Taylor would expand the Medicaid program for the poor, streamline regulations for individual medical policies and offer tax breaks to employers for providing coverage.

It, too, would be expensive: $400 million alone in state and federal funds for expanding Medicaid. But it is attracting important support.

The proposal has the backing of the House leadership, Taylor has said, and leaders of the area's big hospitals seem attracted by a plan that would reduce their uncompensated care but wouldn't overturn their apple carts as would a single-payer system.

Taylor's outline "seems to me to be a more practical approach" than a universal scheme, says Ronald R. Peterson, president of the Johns Hopkins Hospital and Health System.

Business leaders are buying in, too. The Maryland Chamber of Commerce was a co-sponsor of the event at which Taylor introduced the plan. MBRG, the Beilenson idea's main foe, has signed on as the Taylor proposal's biggest fan.

"We have put in place a framework where we can address this very sizable problem," Worcester says. "By the time the primary rolls around, we could arguably elevate this to the No. 1 issue in the state."

Now here's news. Rocky Worcester, perennial advocate of private-sector solutions, talking about addressing a problem with $400 million in new government spending. MBRG in the big tent

Part of the change is explained by the sheer size of the health-coverage problem: big and bigger. Businesses understand they are being drawn into the maelstrom through higher and higher insurance premiums, which in Maryland indirectly subsidize much indigent care.

But the other factor is a regrouping by Maryland's business interests after eight years of the dominant liberalism of Gov. Parris N. Glendening.

The chamber, always more liberal than MBRG, changed tactics in 1999. Champe C. McCulloch, who as chamber leader had taken an aggressive, confrontational stance toward Glendening, gave way to good cop Kathleen T. Snyder, and now MBRG, too, is getting in on the group hugs.

"There was a necessity to reposition MBRG to find new avenues for having influence in public policy" after Democrats thrashed the Republicans in 1998, says Worcester, whose constituency after all is business, not the GOP. "We're identifying macro issues that basically transcend party."

Come on down, says Taylor.

"Basically, Rocky has agreed to use their organization as a venue," he said. "It does give me the opportunity to get into the inner sanctums of some real Republican hotbeds, but if that's what it takes to get the job done, that's fine with me."

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