Columns » Ernest Dumas

Building a health plan

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The biggest and potentially best news in many months was The New York Times’s report of secret meetings of business, union, liberal and conservative groups to produce a national health insurance plan, which they expect to present to Congress and the president by year’s end. Conducted away from the politicians and the public eye, the deliberations are supposed to yield a consensus middle way to dramatically broaden health coverage among the more than 45 million Americans who aren’t insured. Then all 24 of the groups, which sure enough represent enough muscle to sway Congress, will stand united until the program is enacted. That is the idea. While Congress is distracted by President Bush’s futile campaign to alter the character of Social Security, at least someone has their eye on the prize. Health insurance is the nation’s most urgent problem. But let’s not let our hopes soar. If the United States Chamber of Commerce, the Heritage Foundation, the insurance industry and drug companies find common ground with Families USA, AARP and the Service Employees International Union, how broad and helpful could it be? One of the ideas is state insurance purchasing pools, where individuals and small businesses could acquire coverage. The federal government would toss in a little money to help states administer them. But states, including Arkansas, have enacted such laws and they have tended to produce little. Another idea sounds equally familiar: tax credits for poor people and small businesses to help them purchase insurance. That was a big part of President Bush’s health insurance strategy in the campaign. He hasn’t mentioned it since then, for a reason. What benefit are tax credits to the poor unless the government provides a refundable credit large enough itself to buy insurance? Tax credits are nice incentives for the rich, who don’t need them to buy insurance. But the secret deliberations, which we are told were undertaken with some urgency, are a giant step. They are a recognition by big business that universal health insurance is not a scheme of crybaby liberals but a boon to business — no, a necessity for American business now that it has achieved a global economy. Corporations like General Motors, Ford and Daimler-Chrysler are increasingly uncompetitive because of their health-care costs. Arkansas has fresh reason to take notice. The giant Toyota plant that the state had hoped would build at a prime site in Crittenden County apparently will go instead to a site near Toronto, where the company can save more than $4 an hour per worker because Canada furnishes splendid medical coverage for everyone. Of course, the automakers realized that years ago. They supported President Clinton’s universal health care plan until the conservative campaign against it got too hot. Only Chrysler supported it at the end. Chrysler still favors a single-payer national system. General Motors admires the Canadian system but the chairman, who supported the single-payer idea in 1994 when Clinton was crafting his plan, now backs away from calling for the same in the United States, knowing that it will make him a pariah in boardrooms. That is what makes the secret negotiations for a national health program such a longshot for producing real remedies. A single-payer system apparently is off the table, and probably even a hybrid system that would be publicly financed and privately administered. The Times’ report said the participants worried about significantly increasing health-care spending, an element of almost any plan to enlarge coverage that doesn’t embrace the single-payer system. A single-payer system is the only way to avoid dramatically higher costs. You see, while Americans have less access to health care than almost every developed country, they spend far more on health care than all the others. In short, we spend more, get less. In 2001, the United States devoted 13.9 percent of GDP to medical care, compared with 9.7 percent in Canada, 9.5 percent in France and 8.7 percent in Sweden, countries with universal single-payer systems. The Centers for Medicare and Medicaid Services expects healthcare outlays in the United States to rise from $1.8 trillion in 2004 to $2.7 trillion in 2010 with a smaller and smaller share of people covered. Much of the money — more than 30 percent — is spent on administration, or trying to get someone else to pay the bill. A study published in the International Journal of Health Services concluded that the country wastes more on healthcare bureaucracy than it would take to cover every single American. That part of the current system, the wasteful one, is the one part that the negotiators apparently are committed to maintain. But you can build on that. Hillary Clinton did in the failed 1994 plan. It would have maintained private administration, but the federal government would have made everyone, including every business, a player. Private insurance would have been acquired competitively through state and regional purchasing pools. It would be expensive but by maintaining the present system, waste and all, it should meet the test of the negotiators. If someone stripped out a thousand pages of needless rules and didn’t mention Hillary’s name, it would fly tomorrow.

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