John Edwards got the discussion of health-care reform moving in Democratic circles. His proposal to set up government-run "health markets" to compete with private insurers might move the US toward a more efficient national health program. But his talking point for next year's presidential campaign is no reason progressive populists should stop promoting expansion of Medicare for all Americans in the current Congress.
President Bush has ignored the plight of the 47 million Americans who are uninsured and the tens of millions of others who are underinsured or at risk of losing coverage. He has tried to cut funding for Medicare and Medicaid and to undermine Social Security. He signed draconian bankruptcy limitations that show no mercy to Americans who incur ruinous medical expenses. His major initiative to control health care costs has been to limit malpractice lawsuits by injured patients.
Bush now proposes to provide tax breaks for individuals to buy private health insurance -- a plan that is virtually useless for the working poor who need the help the most. He would pay for the program by taxing benefits of working people -- mainly union members -- who get health coverage through their jobs.
Bush's new budget proposes to add $5 billion to the State Children's Health Insurance Program, which was established 10 years ago for children of the working poor who don't qualify for Medicaid. But Bush wants to discourage states from expanding the program from its "original objective" of covering children with family incomes less than twice the poverty level. Advocates in Congress believe $12 billion to $15 billion is needed, according to the Wall Street Journal, and some Democrats would like to see even more funds to extend the program's coverage.
Prominent Democrats, many Republicans and even some industry groups are paying lip service to the need to expand health care. But most action has been at the state level.
Sixteen states already cover children in families above 200% of the poverty level, and some states want to go higher. The National Conference of State Legislatures reported that health care reform was hot in state legislatures in 2006 and the forecast for this year is even hotter.
The New York Times reported that Arkansas, Kentucky, Montana, Oklahoma, Rhode Island and Tennessee have new laws and programs to reduce the cost of insurance for small employers. Massachusetts and Vermont passed laws in 2006 to move toward universal coverage, while addressing the cost and quality of care. Several states, including Colorado and Delaware, are requiring insurers to cover young adults, the fastest-growing segment of the uninsured population.
Ultimately, the best answer is to expand Medicare to cover all Americans. US Rep. John Conyers, D-Mich., has a National Health Insurance Act (HR 676), which would do just that. But many progressive health policy experts do not believe they can muster support for a single-payer plan in the face of public doubts reinforced by insurance industry money.
Don McCanne, M.D., senior health policy fellow of Physicians for a National Health Program (pnhp.org), a supporter of Conyers' bill, wrote that polls demonstrate strong support for Medicare, but they also support employer-sponsored plans, which cover 59% of the nation. "In spite of polls indicating strong support for single payer or Medicare for All, there is a very real reluctance to give up private plans perceived as largely funded by the employers in exchange for a government-run program, especially since many equate that with queues and rationing," McCanne wrote.
Edwards instead proposes to cover the uninsured with a combination of regulation and financial aid. But unlike Bush, Edwards would require businesses to either cover their workers or help finance their health insurance.
To stop private insurance companies from cherry-picking healthy customers and leaving the chronically ill to the charity wards, Edwards would set up regional "health markets" that would provide affordable, high-quality insurance plans at lower costs. These markets would offer a choice between private insurers and a public insurance plan modeled after Medicare. "Over time, the system may evolve toward a single-payer approach if individuals and busineses prefer the public plan," Edwards said.
The plan will cost between $90 billion and $120 billion a year. Edwards said he would pay for it by rolling back tax breaks for incomes higher than $200,000 a year.
Paul Krugman of the New York Times noted that Edwards' proposal addresses both the problem of the uninsured and the waste and inefficiency of the fragmented private insurance system. And every candidate should be pressed to come up with something comparable -- not just general support for universal health care or building consensus.
Edwards' plan might appear to have a better chance to get through Congress, but the insurance rackets will fight it just like they would a straight single-payer bill such as Conyers' HR 676.
Frankly, neither plan is expected to get out of this Congress, because the Republican Party simply has not shown real concern about the problems of working families and will block any reforms that threaten insurance corporate profits.
But health-care advocates have a right to be skeptical of industry-sponsored coalitions to "reform" health care. When Wal-Mart CEO Lee Scott appeared with Service Employees International Union President Andy Stern and other business and public-interest organizations on Feb. 7 to express support for health care reforms, Scott admitted to the news media that Wal-Mart would not stop funding candidates who oppose universal health coverage.
Since that is the case, the Dems ought to put the Medicare expansion bill on the fast track in the House and place it on the Senate agenda. The bill has support of organized labor and it would cut health costs for businesses. Force the GOP to filibuster it and put "on the record" the plutocrats who oppose health care for all.
Those plutocrats will spend a trillion dollars to occupy Iraq and push for a fight with Iran but they won't pony up the money to provide basic health care for all US citizens. Democrats who cannot figure out how to frame health care for all as a winning campaign issue ought to pack it in.
First Republicans crowed about their success in shutting down the Senate debate about the escalation of the Iraq war. Then they complained that they were being blamed for stifling the debate. On Feb. 5, 46 Republicans, along with Sen. Joe Lieberman, voted to uphold the GOP filibuster of the non-binding Warner-Levin resolution opposing the "surge." (One of those who voted for the filibuster was Sen. John Warner, R-Va., so he voted to suppress his own resolution.) Two Republicans -- Susan Collins and Norm Coleman -- joined 47 Democrats to advance the anti-surge resolution. That left the Dems 11 short of the 60 needed to break the filibuster. Seven Republicans, including Warner and four others who had supported the filibuster, later signed a letter advising Senate leaders that they intended to attach the resolution to bills coming before the Senate.
All this fuss, mind you, is over a non-binding resolution, but as far as we're concerned the filibuster vote accomplished the same thing: It put senators on record opposing the "surge" by a 49-47 margin. (Sens. John McCain and Mel Martinez missed the vote.) The Senate, in effect, voted no confidence in the president. The House is set to adopt an anti-surge resolution as we go to press. It won't stop Bush from continuing the surge; he and Cheney have contempt for Congress and the rule of law and it appears that nothing shot of impeachment of the pair of them will do the trick. But that will not happen until Republican voters turn on their senators. -- JMC
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