Columns » Warwick Sabin

Time to compromise

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If you had to pick one thing to which the successes of the Clinton administration could be attributed, it would have to be the art of compromise.

Bill Clinton was able to protect New Deal and Great Society programs while cutting taxes and deficits and reducing the size of the federal government. Of course, he didn’t satisfy the extreme elements of the left and right, who view compromise as betrayal.

But Clinton’s compromises contributed to economic growth and widespread prosperity. After all, compromise between rival factions produced our system of government and optimizes its performance. Many of the problems of the last five years are the result of an administration that refuses to compromise.

Nowhere is this more in evidence than in health care. The new Medicare prescription drug plan has produced a crisis among seniors who suddenly cannot afford their medicine, which led Gov. Mike Huckabee to declare a “state health emergency” last week. In many ways this system was designed to fail, conceived by pharmaceutical companies that want to charge market prices and their Bush administration enablers who are ideologically opposed to government assistance.

At the same time, the Maryland legislature last week overrode the governor’s veto on a bill that forces companies with more than 10,000 in-state employees to spend at least 8 percent of their payroll on employee health insurance or pay the difference into the state’s Medicaid fund. As it happens, the new law only applies to Wal-Mart, which has been under fire for shifting most of its health care responsibilities to taxpayers through Medicaid.

So on the one hand you have conservatives trying to destroy health care entitlements at the expense of seniors who will suffer physically if denied access to prescription drugs. On the other hand you have liberals who could ultimately destroy businesses large and small if they enforce health care spending mandates.

It’s easy to understand how we got here. Health insurance is too expensive for most average Americans to afford on their own, so most go without if they are not covered by an employer’s plan. If they get sick or hurt and can’t pay for their treatment, health care costs go up for everyone, including the employer. Eventually the employer can’t afford to offer health insurance, which makes him look like a bad guy.

Since when did we become a nation that allows its citizens to get sick and die for lack of money? Since when did we become a nation that makes impossible demands of business?

It is high time for compromise, and the most logical solution is a single-payer health insurance system managed by the federal government.

That means every citizen contributes to, and is covered by, a national health insurance system. Risk is distributed among a pool of hundreds of millions of people, which reduces costs. This is not “socialized medicine,” because the health care delivery system would remain private.

Through this compromise, everyone has access to health care without burdening businesses with the expense. As Matt Bai recently wrote in the New York Times Magazine, our changing society and competitive pressures demand a new approach to how we structure the system.

“Does it make sense to expect businesses to finance lavish health care plans when foreign competition is forcing companies to cut their costs?” Bai wrote. “Isn’t government better equipped to insure a nomadic work force while employers take on the more manageable task of childcare — a problem that hardly existed 50 years ago? If government were to remove the burden of health care costs from businesses, enabling them to better compete, wouldn’t it then be more reasonable to create disincentives for employers who are thinking of shipping their jobs overseas? Isn’t the very notion of a payroll tax for workers antiquated and inequitable in a society where so many Americans earn stock dividends and where a growing number are self-employed?”

Our system is broken today because both sides of the ideological spectrum refuse to come together to earnestly address these issues and fashion a compromise. For a workable solution to emerge, neither side can insist on total victory. A single-payer arrangement has the advantage of combining more efficient total individual coverage while preserving private health care delivery and reducing costs to businesses.

The alternative is to do nothing and allow the current system to become increasingly dysfunctional until it eventually becomes unsustainable and dies. That would at least satisfy one side.


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