HEALTH CARE/Joan Retsinas

Dear Santa

It's time for my annual letter to you. Fresh from giving thanks for all the bounties of prosperity at Thanksgiving, I am compiling my wish list for more bounties. That is the schizoid nature of this season: gratitude followed by greed.

But I'm unabashedly making my same old request: universal health insurance -- a one-card system that gives every American access to our wonderful doctors and hospitals (thank you for the wonderful doctors and hospitals). European countries have this. I want it too.

I know. I know. I've asked you for this before. In 1935. In 1946. In 1950. In 1965. Eight years ago. And each time I semi-graciously acknowledged that the time wasn't right. In 1935 Social Security was a big enough holiday gift -- the greediest citizen couldn't expect you to tack on health insurance too. In 1946 you gave hospitals a mammoth boost with Hill Burton legislation -- thanks to you, Congress pored millions of dollars into hospital construction throughout the nation. It was too much to expect, as some senators did, that you could give us a health insurance package too. In 1950 I put it on my wish list -- you got President Truman to talk about it. But no go. In 1965 you gave us a partial gift -- universal health insurance, but only for the disabled and elderly. Again, I'm grateful, but still want more. As for 1992, maybe the whole shebang -- health insurance for everybody -- was just too much to ask for. Greedy aspirants generally get coals in their stockings, don't they? But it has been eight years, and I'm weighing back in with the same old same old.

This time you are my last recourse. I've given up on the new President -- neither the Democratic nor the Republican candidate promised universal health insurance during their campaigns, and they promised lots of other goodies. Senator Bill Bradley, the only Presidential candidate to float a detailed proposal for national health insurance, didn't survive the primaries. Congressional solons are not waxing hysterical about the persistent pool of people without insurance. Why should they? Our elected leaders all have health insurance by virtue of being in Congress. And all are wealthy enough to buy insurance on their own if their constituents dump them -- a rare occurrence in American politicaldom.

So, Santa, I'm bringing my cause to you.

I know that most Americans have dropped "health care" from their annual wish lists. In a post-voting poll, a sample of voters named their key desire (aside from character, which the pollsters took off the table). Most (24%) want to save Social Security (though it is in no imminent danger); 23% care about education; 16% care about abortion; 13% about taxes, 12% about the economy (which -- thank you -- is roaring along superbly). Only 11% put "health care" at the top of their wish list; and some of them are asking you for prescription drug coverage.

But the 43 million of us who lack insurance are a tenacious lot. In general, we haven't been especially good or especially bad this year -- certainly not bad enough to end up waiting in hospital emergency rooms, hoping on the one hand that we are sick enough for somebody to look at us, hoping on the other hand that we aren't truly that sick. We don't deserve our plight. Most of us work, earning just enough to fall into that oxymoron category, "the working poor." Either we have the bad fortune to work for employers who don't offer health insurance as a fringe benefit. Or we can't afford to buy the insurance that our employers do offer.

Santa, you have dropped "health care stuffers" into our holiday stockings in past year. We have COBRA, which lets us, or our families, buy insurance at our employer's group rates if we leave the job. That helps -- thank you -- but few people can afford to pay even the group rates, especially people who have lost their jobs. Medicaid now enrolls children, and, in some states, their parents, whose income falls above strict Medicaid levels. That too helps. We have special funds to pay for breast cancer treatment for uninsured women diagnosed with breast cancer -- again, thank you.

Those stocking stuffers, though, don't suffice. We still want the whole shebang -- a "health insurance card," like the Medicare card all Americans get when they reach age 65. You can take back COBRA, Medicaid, and the special programs for special populations. We won't need them anymore.


An Ever-Believing Virginia

Joan Retsinas is a sociologist who writes about health care in Providence, Rhode Island.

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