Political Coverage

Universal health care returns as a political issue. But will it ever happen?

Fri Jan. 16, 2004 4:00 AM EST

It remains a national outrage that in the richest country in the history of the world, 43 million people are without health insurance. How come? Partly, of course, because universal coverage, however appealing as a notion (and right as a principle), is perceived as being too costly, too Big-Government, to sustain much political momentum. Bill Clinton's spectacular failure, ten years ago, to get a comprehensive health plan through Congress stands as a warning to any politcian with ideas of overhauling America's health care system.

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Against these odds, and hoping to move the issue to front and center in an election year, the Institute of Medicine, a prestigious arm of the National Academies of Science, issued a report on Wednesday arguing that providing health insurance for all Americans is a national priority.

The report, the most detailed, authoritative examination of the subject to date, says, "The lack of health insurance for tens of millions of Americans has serious negative consequences and economic costs not only for the uninsured themselves but also for their families, the communities they live in, and the whole country," and calls on Congress and the president to implement universal coverage by 2010.

The IOM doesn't specify a method for achieving such broad health coverage, or attach a price tag (though it does estimate that the uninsured cost the country between $65 billion and $130 billion a year); instead, it outlines several principles the government could follow, and against which any political platform should be measured. The report concludes that universal coverage would, "enrich all Americans ... in terms of improved health ... greater economic productivity, financial security or the stabilization of communities' health care systems."

Tommy G. Thompson, the secretary of health and human services, gave the report a tepid response, saying its goals were unrealistic, but that the administration was "committed to helping as many Americans as possible, as quickly as possible." However Bob Dole, former presidential candidate and erstwhile Republican leader of the Senate, told the press that the report was a important call to action. "If properly framed, the lack of coverage for 43 million Americans can be one of the big, big issues in the election," he said.

The Bush administration may have not have plans to guarantee health care for all Americans, but the Democrats vying for office are making health care an important campaign issue, having, of course, the luxury of thinking big on the issue without having to deliver any time soon. The candidates disagree on how coverage should be expanded but all are attempting to gain some traction what they hope is a hot-button issue.

Dick Gephardt's initiative would cover everyone, in part by offering large tax breaks to employers who offer insurance to their employees, at a cost of at least $214 billion a year. His plan would also offer federal health insurance for the unemployed. Howard Dean promotes his record, as governor of Vermont, of achieving near universal coverage of children, and likes to say, "This is not some crackpot liberal idea from Vermont — Harry Truman put universal health insurance in the 1948 Democratic platform." His plan would cover most of the uninsured at a cost of around $90 billion, to be paid for in part by rolling back the Bush tax cuts. Dean likes to sell his proposal as the "most politically realistic."

Joe Lieberman and John Edwards propose extending benefits to include all children. John Kerry advocates expanding coverage through the well regarded the Federal Employees Health Benefits Program. Dennis Kucinich and Rev. Al Sharpton propose a publicly funded, single-payer universal health care system, but none of the top candidates have made proposals that come near Clinton's plan for ambition. Emory University professor Kenneth Thorpe, who helped Clinton draft his health care initiative, told the Tribune that today's candidates learned from Clinton's mistakes.

"Clinton wanted to fundamentally change how we get health insurance...These candidates are not trying to reinvent the wheel. One lesson we learned was not to take on the 180 million people who already have insurance and create a lot of anxiety.... The political strategy now is to build on what we've got."

The Bush administration rejects the idea that spending more federal money is the best way to provide insurance for Americans. The president, in extending drug benefits last year, did succeed in completing the biggest Medicare expansion in 38 years, but doesn't help the uninsured. According to a numbers breakdown in the New York Times Dean, Lieberman and Clark's plans would cover about 31 million of the uninsured, Kerry 27 million, and Edwards 21 million. With the rate of the uninsured rising, such plans could become key issues in the primaries. But, as Clinton's experience shows, when it comes to health care, talk is cheap, but universal coverage can be very expensive -- politically as well as financially.

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