Universal Health

WE NEED universal health insurance because 37 million Americans have no health insurance to pay the doctor, right?Wrong. Our present system does leave a lot of people out -- but that's not the worst thing that ails it. Worse still is how it squanders scarce resources and increasingly denies freedom of choice to consumers.Conservative critics will tell you that universal health systems like the Canadian one are guilty of the sin of "rationing." The Wall Street Journal recently RobertKuttnerran an editorial column titled, "Canadians Cross Border to Save Their Lives."

A member of one of America's wealthiest families has decried the lack of effort by the White House to promote universal access to health care for all Americans."

WASHINGTON -- For Sen. Hillary Rodham Clinton, the problems of the U.S. health care system have been a political danger zone since she unsuccessfully tackled the issue as first lady in the early 1990s. Health insurers and conservatives vilified Clinton for her efforts then, and Congress reacted coolly to her presentation of a universal health care plan as a fait accompli after months of secret meetings. Yesterday, as a candidate for president, the New York Democrat returned to the complicated and contentious topic, acknowledging mistakes and promising that she had learned from them.

AMERICANS have embraced our individual right to limit heroic but futile medical treatment at life's end with such documents as an advance directive, living will and health- care proxy.How can we combine this ethical consensus with the economics of rationing care?The coming reform of our health-care system may provide an opportunity.First, current law should be amended to require all registrants for federal entitlement programs -- Medicare, Medicaid and Social Security benefits -- to consider and complete an advance directive.

Washington -- NOW BEGINS the endgame. If everything breaks just right, we will get a better health care system. Otherwise, we will miss a window for reform. And we could wind up with a hodgepodge worse than what we have now.From the outset, health reform had to marry three seemingly contradictory goals: universal coverage, cost containment and free choice of health plans. For the middle class, universal coverage means guaranteeing that insurance is fully portable -- not vulnerable to discrimination because of pre-existing conditions.

Sidestepping a no-new-taxes pledge, Lt. Gov. Kathleen Kennedy Townsend said yesterday she supports a 36-cent-a-pack increase in Maryland's cigarette tax to pay for health care for the uninsured. Townsend said she would ask for the increase in the second year of her administration if elected governor, maintaining her commitment not to raise taxes in the first year - when state officials will grapple with an estimated $900 million budget shortfall and an uncertain economy. "I want to make sure the money is used for expanded coverage, not filling in gaps," Townsend said.

MAYBE THE health care dilemma in America needs Alice or the Mad Hatter. Perhaps those characters could keep their balance while falling through the looking glass of legislation, power politics, the promise of a free lunch and assorted phantasmagoric obstacles. The looking glass imagery comes from Health Secretary Nelson J. Sabatini, who says the pathway to a rational, comprehensive, universal health insurance system will require thinking outside the wonderland. He offers two examples.

BILL Clinton's presidency is on the verge of a downward spiral in which perceived weakness produces further weakness. If he does not pull up on the stick, Mr. Clinton will have little to take to the voters either in the mid-term elections of 1994, or in 1996.The recent defection of conservative House Democrats over energy taxes and social spending is only the latest example. As the president seems vulnerable and vacillating, each interest group and each party faction figures it has nothing to lose by holding the president's program hostage for its own parochial demands -- which only weakens him further.

Universal health care is the real solution The Baltimore Sun's three-part series "In Their Debt" (Dec. 21-Dec. 23) was more compelling when it pointed to the failings of the current health care financing model than when it questioned the efficacy of Maryland's unique "all-payer" hospital rate-setting model. While we spend far more than any other country on health care, about 46 million people in this country (including 800,000 in Maryland) have no health insurance and millions more have inadequate insurance.

Under mounting pressure and facing growing criticism, the state insurance commissioner abruptly reversed himself yesterday, canceling plans to sell a troubled health maintenance organization to a group of minority physicians for $2 million. Commissioner Steven B. Larsen said he abandoned the sale plan because the physicians' group, Universal Health Plan of Lanham, had failed to disclose important financial details when it submitted its final bid earlier this year. The financial information that led to the cancellation was disclosed by Universal after the proposed sale had been filed and announced, he said.