A Down Payment for Universal Health Care

The federal government is looking at a trillion-dollar surplus over the next decade but Republicans, as usual, want to spend it on tax breaks for their wealthy benefactors. And "New Democrats" appear willing to go along it.

For years we've been hearing from the conservatives that the Social Security and Medicare systems were headed for funding crises. Either they were lying then or they're lying now when they say we can spend $800 billion on tax breaks.

There's never enough money to do anything for ordinary working people, and we stand to get little out of this windfall under the plans that are currently getting aired.

President Clinton, for his part, has proposed allocating enough money to keep Social Security solvent beyond 2050, even with the pessimistic growth projections that fueled the scare.

He also would put additional money into Medicare, offering new prescription drug benefits, but he would add out-of-pocket costs to consumers and cut reimbursements to hospitals, many of which already are complaining about funding levels, particularly in rural areas.

A ''children's and education trust fund'' would pump more funds into Head Start, child care, children's health and classroom teaching. A worthy goal, but hardly a legacy.

As a sop to conservatives, Clinton proposed using some of the surplus to pay off the entire national debt by the year 2015 (a questionable goal from a monetary standpoint), and he has proposed $250 billion in tax cuts.

Sen. Bob Torricelli (D-N.J.), who is responsible for raising funds for the next round of Democratic Senate campaigns, has cosponsored a ''middle class'' tax cut bill with Paul Coverdell (R-Ga.) that would actually benefit only the top one-fourth of taxpayers -- generally families making more than $60,000 a year.

As we approach another presidential election year, both Al Gore and Bill Bradley are heading for the center, where they find Republican Texas Gov. George W. Bush, the self-styled "compassionate conservative." President Clinton complains that Bush is sounding more and more like a Democrat. That's hardly a comfort for those of us who have watched the Democratic Party sell out its progressive and populist wings over the past few years.

Republicans showed their colors last month in the debate over a patients "bill of rights." The GOP did the very least they could without harming the profit margins of the insurance companies. The Democrat offered amendments, such as the one that would have given patients the right to sue when HMO managers deny treatment. The Republicans voted them down and instead provided tax breaks for medical savings accounts and some protections for the 48 million people who get health coverage from self-insured companies, which are not regulated by states. For 123 million who get insurance through private employers, the GOP created an appeals process when even those miserly benefits are denied.

Neither the Republican nor the Democratic "bills of rights" would do a thing for the 43 million uninsured Americans, mainly the working poor who cannot afford health insurance for themselves or their children. Neither version offers relief for the small businesses that face the choice of paying hefty increases in premiums or casting their employees adrift without coverage. Nor does either version offer choices for workers who are forced into stingy HMOs.

There is a bill before Congress that would provide health care for every American and would free patients as well as their doctors from the tyranny of HMO bureaucrats. The American Health Security Act (HR 1200), sponsored by Rep. James McDermott (D-Wash.) would provide universal health coverage for all Americans as of January 1, 2001. The federal government would define the standard benefit package, collect the premiums and distribute funds to the states. The states would negotiate fees with health care providers.

Patients would visit the doctor of their choice, who would bill the state for services provided. The state would pay the bill, just as insurance companies pay medical bills now. The difference is that there would be no complicated and expensive formulas for patient co-payments, coinsurance, and deductibles in addition to premium costs.

Such a program could cover all inpatient and outpatient medical services without limits on duration or intensity as required for the patient's recovery, said McDermott, a psychiatrist. It provides for coverage of comprehensive long-term care, dental services, mental health services and prescription drugs. Cosmetic procedures and other "frill" benefits such as private rooms and comfort items would not be covered.

Everyone would contribute to the health insurance system, except the very poor. Employers would pay 8.7% of their payroll while individuals would pay 2.2% of their taxable income. A tobacco tax of 45 cents per pack also would be imposed. McDermott notes that these payroll deductions are lower than current insurance costs for most businesses and individuals, even while providing universal coverage and a more generous benefit package than exists in the private market today.

The Joint Committee on Taxation has estimated that the American Health Security Act would generate a surplus of $100 billion per year by the year 2004.

"The key is that the money necessary to provide coverage to people who cannot afford it comes from the administrative savings achieved through the elimination of the insurance company middle man," he writes in his summary of the bill (available at www.house.gov/mcdermott/issues.html or phone 202-225-3106).

Yet this bill has received practically no attention and languishes in subcommittee.

Congress also could simply expand Medicare to cover all Americans. While conservatives want to privatize Medicare or cut back its benefits, Dr. Thomas Bodenheimer M.D. of Medicare for All (phone 415-395-7959 or see www.medicare4all.org) estimates in the year 2001 it would cost $136 billion to add prescription drugs, long-term care and expand Medicare to cover everyone in the nation.

That assumes the $583 million already spent on Medicare, Medicaid and other government health programs would be channeled into the Medicare program, as well as the $397 billion now spent on employer-sponsored health insurance.

That leaves $136 billion to be financed by new revenues. That would be more than covered by the $219 billion Americans otherwise would spend out of pocket on uninsured medical expenses.

New revenues could be generated by a combination of increase in payroll taxes, eliminating the Social Security income cap on payroll taxes, surcharges on high-income households, non-wage income, alcohol, corporate taxes and estate taxes as well as the budget surplus and holding down military spending.

Bodenheimer adds that Medicare could control health costs better than the costly HMOs. "Evidence is building that the for-profit managed care marketplace will fail to control health care costs and that government-regulated programs such as Medicare can control costs better. (In 1998, the private marketplace inflated at 6.1% while Medicare inflated at only 1.5%) As the managed care marketplace fails to control costs, government and business will have little choice but to support a publicly budgeted universal Medicare program."

That trillion-dollar surplus would be best spent as a down payment on a universal health care plan. Most working Americans would get better health coverage at little or no increase out of their own pocket, and most small businesses would pay less on insurance premiums. If Democrats got behind such a plan and gave working-class Americans a solid reason to vote Democratic, their chances to retain the White House and regain control of Congress in 2000 would leap forward. -- Jim Cullen

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