From 20,000 feet, the sky is misleadingly clear

November 23, 2003|By C. Fraser Smith

THE SWEET air of Indian summer embraced the health care forum in Annapolis recently as Gov. Robert L. Ehrlich Jr. and a variety of other figures declared their commitment to providing health insurance for all Marylanders.

There was an atmosphere of cooperation, a problem-solving atmosphere, an atmosphere free of recrimination - though it floated on an undertone of wariness.

Why? Because the summit's lofty goal, insuring the 600,000 or so Marylanders without coverage, is out of reach. There's no money for a proposal that could cost $600 million a year. Who wasn't aware of the state's ongoing budget deficit?

"There's many a slip twixt cup and lip," according to an old English proverb. In this case, the cup is empty, so getting it to the lip is a chore of dubious value.

Mr. Ehrlich opened the proceedings with his health secretary, Nelson J. Sabatini, at his side. Mr. Sabatini, who several months ago declared the governor's endorsement of universal health insurance, offered down-the-road hope. An expert in health care financing, the secretary has been pushing Mr. Ehrlich to do something. He's making a strong inside case for problem-solving.

"To say we won't do anything until times get better is not a satisfactory answer, because things will get worse," he said after the governor's remarks.

There's no money to finance a comprehensive health insurance plan with tax credits for employers who provide the insurance, the governor's favored approach. Tax credits mean forgiven taxes, more or less.

But a government facing a deficit of $700 million, give or take, can't even think about forgiving revenue.

A few days after the summit, Mr. Ehrlich pressed his determination to take another $700 million out of the general fund. He has to cut to balance the budget - since he won't raise taxes. (A penny on the sales tax would yield about $600 million, enough to pay for the insurance program or to erase most of the $700 million deficit.) Where's the hope then? In the sheer willingness to consider the issue, perhaps.

A group called Health Care for All proposes a mM-ilange of revenue-raising ideas, which include a higher cigarette tax and a tax on employers who don't provide health insurance. Mr. Ehrlich seems unlikely to find anything likable in this scenario. He has promised to veto bills that include new or higher taxes.

It's too early to say what he'd do with any proposal, because the political, legislative and financial picture will not come into focus for months. Perhaps the wisdom of making the system smarter will work a change in his thinking. Perhaps polling will show voters want health insurance for all. But it is safe to say proposals including the word tax or tax increase have the proverbial chances of slim and none.

Mr. Sabatini said there were no villains in the play. It's a generous benediction.

Villains or not, says Del. John Adams Hurson, chairman of the House committee on health, those who gathered for the health confab need to recognize the difference between the view from the summit - 20,000 feet or so above the rocky terrain of lawmaking. Many who came together with hosannas of harmony will want veto power over some aspect of whatever legislation is offered. They're ready to kill or excise the parts they don't like.

A Baltimore doctor offered an update on the decision to require premium payments from families with income above 185 percent of the federal poverty guideline. Many of those families have dropped out of the system. An attempt to contact about 200 of these families in Baltimore was thwarted, in part because 50 had disconnected phone service.

Smarter, pragmatic policy would forgo the premium, the doctor says. "When they do get sick, the kid pays, the family pays and we pay," he said. No wonder the prospects at ground level are so sobering. Policy-making will require not only money but Solomonic judgment and even more of the summit's problem-solving spirit.

C. Fraser Smith is news director for WYPR-FM, and his column appears Sundays.

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