Universal health plan rejected in Oregon

The defeat of an initiative to provide health care for all Oregonians has not deterred Mark Lindgren, chair of Health Care for All-Oregon. In an analysis at the Physicians for a National Health Program website (www.pnhp.org) he wrote that the Oregon experience shows what an under-funded, volunteer-based health care campaign can accomplish, as well as the limitations of such an approach. After an Oct. 11 poll showed a virtually dead heat in support for single-payer health coverage, he said, the insurance industry tripled its spending to at least $1.2 million, bankrolling a negative campaign that portrayed the measure as providing unlimited services and raising taxes for individuals and businesses. The single-payer advocates were able to raise and spend only about $90,000, of which $55,000 had gone to collect petition signatures to put the measure on the ballot. The final yes vote was only 21% in favor, just over a quarter of a million votes.

The plan promised comprehensive coverage, including prescription drugs, inpatient and outpatient services, vision, dental, mental health, long-term care, and alternative medicine, with no copays or deductibles.

More than a third of the funding would have come from money already spent by federal, state, and local governments. The rest would have come from an income tax of up to 8% of taxable income, exempting families with incomes 150% or less of the federal poverty level, and a progressive employer payroll tax from 3% to 11.5%.

The campaign tried to capitalize on widespread middle-class worry about health care, but it was hurt when the state AFL-CIO came out in opposition, which also scared off many elected officials, Lindgren wrote. The unions did not want more than 20% of the new funding for the plan to come from income taxes (workers would have paid about 43% of the cost of the plan). The Oregon Nurses Association was neutral and many medical groups opposed it, though many individual doctors supported it.

Some physicians and hospitals were nervous about the plan, fearing the administrative board would negotiate below-cost payment to providers, as current government programs do. Some doctors, as employers, also were not happy about being taxed under the plan, he said.

The insurance industry stayed in the background, letting the National Federation of Independent Businesses take the public face of the opposition. An NFIB spokesman was on record that businesses simply did not want a mandate to participate.

Lindgren said he hoped to work with some of those stakeholder groups to shape a revised measure, perhaps for the 2004 ballot.

The National Academy of Sciences on Nov. 19 called on the Bush administration to immediately test possible solutions, including universal insurance coverage and no-fault payment for medical malpractice, in a handful of states. Al Gore, who recently found his voice after two years in the political wilderness, has joined Vermont Gov. Howard Dean among the presumptive Democratic presidential candidates calling for universal health coverage. The New York Times reported Nov. 25 that an increasing number of uninsured are middle-class families whose breadwinners are unable to afford health coverage as employers pass more health care costs on to them.

George W. Bush has proposed tax credits to help pay for health insurance while Democrats favor expansion of Medicaid and the Children's Health Insurance Program to cover the working poor. A bill sponsored by Sens. Susan Collins, R-Maine, and Mary L. Landrieu, D-La., would combine those approaches and provide federal money to the states to establish insurance purchasing cooperatives for small businesses and high-risk pools for people who cannot get insurance in the private market because of chronic illnesses. Sen. Ted Kennedy, D-Mass., plans legislation that would require all employers with more than five workers to provide health insurance for employees and their dependents. For those with low incomes, the government would offer subsidies to help pay premiums.

Other states already are studying universal health care. A report to the Rhode Island General Assembly found that a single-payer universal health care system could provide comprehensive care for the state's 75,000 uninsured residents as well as those who already have insurance coverage and save the state $270 million in health care costs.

The Universal Health Care Action Network (at www.uhcan.org) has information on several state campaigns for universal health care. -- JMC