[NYTr] Will We Ever Get National Health Insurance?

[All the News That Doesn't Fit]

sent by Steven L. Robinson (activ-l)

History News Network - Aug 6, 2007
http://hnn.us/articles/41314.html

Will We Ever Get National Health Insurance?

By Jill Quadagno

Last year nearly a million more people were uninsured compared to the
year before, nearly 48 million in all. The employer-based system that
most people of working age have relied on since the 1950s is unraveling
at the seams. Each year for more than a decade the percentage of
employers offering health benefits has declined.  The only reason the
situation doesn't look worse is that the government is picking up the
slack - through Medicare and Medicaid and through the coverage provided
to public employees.

Most uninsured people do not have a regular family doctor and thus do
not receive preventive care like cholesterol-lowering drugs or
screening for cancer and heart disease.  Frequently the care they do
receive is in an emergency room where there are no follow-up services.
Many receive no care at all, because hospitals have been closing in
poor neighborhoods where there are large numbers of uninsured people.

The dilemma of the uninsured reverberates throughout the economy, as the
cost of their care is borne by taxpayers through government programs or
through cost shifting by physicians and hospitals to privately insured
patients. Cost shifting, in turn, forces insurance companies to raise
premiums. As premiums rise, fewer employers offer coverage.  Some
companies have been pushed to the brink of bankruptcy by rising health
care costs.

Other nations, regardless of how they raise funds, organize care, and
determine eligibility, guarantee every citizen comprehensive coverage
for essential health care services.  Most countries allow, and some
encourage, private insurance as an upgrade or second tier to a higher
class of service and a fuller array of services.  But the practices of
these companies are heavily regulated to prevent them from engaging in
the sophisticated forms of medical "underwriting" used by insurance
companies in the United States to segment people and employee groups
into different risk pools. Underwriting allows insurers to charge more
to cover people who have allergies, high blood pressure, depression or
arthritis, exclude "preexisting conditions" such as cataracts, asthma,
or migraine headaches and deny coverage entirely to older people or
people with serious illnesses like AIDS, leukemia, or emphysema.

How did the United States arrive at this vexing dilemma?  This answer is
that across the entire span of the 20th century each attempt to enact
national health insurance was met with fierce attacks by powerful
stakeholders who mobilized their considerable resources to keep the
financing of health care a private affair.  In the first half of the
century, physicians led the anti-reform coalition, fearful that
government entry would mean government control of medical practice and
fees.  What allowed physicians to insert their parochial concerns into
the political process was the fact that they had the support of
powerful allies with greater clout and deeper pockets -- insurance
companies, the Chamber of Commerce and the National Association of
Manufacturers.

When President Harry Truman made national health insurance the key
domestic issue of his Fair Deal, the American Medical Association
converted its state and local medical societies into a political
machine.  The message promoted in every venue was that national health
insurance was socialized medicine, part of a Communist plot to destroy
freedom.  The AMA also mobilized politically to defeat Democratic
candidates who supported national health insurance.  Doctors, nurses,
dentists and office assistants mailed nearly 200,000 letters endorsing
Republican candidates who opposed national health insurance. Physicians
also sent personal letters to their patients, explaining that there
were "evil forces creeping into this country" and asking them to vote
for Republican candidates. In the 1950 election six Democratic senators
who had supported national health insurance were defeated.

After Medicare was enacted in 1965, physicians learned that they could
live with, and indeed profit from, a government program.  After all,
the AMA won concessions guaranteeing that the government would not
control doctors' fees or hospital charges and that private insurers
would administer Medicare.  As they receded from the battle's front
lines, the insurance industry assumed a leading role against reform.

When President Bill Clinton proposed a plan, Health Security, to
guarantee universal health care coverage in 1992, a coalition of
insurers, corporations, and small business groups mobilized against
him. At first it seemed Clinton might have some business allies and
even support from some large insurance companies.  But when the details
of his plan emerged, his allies turned against him.  The most vehement
opponent of Health Security was the Health Insurance Association of
America.  The HIAA spent more than $15 million in a multi-faceted
advertising campaign, sponsored television commercials lambasting
health care reform, and formed "swat teams" to write letters and lobby
lawmakers.  The effort produced more than 450 thousand contacts with
members of Congress, almost a thousand for each senator and congressman.

Insurance agents' organizations also increased their campaign
contributions with the largest sums going to members of the House Ways
and Means and Senate Finance Committees, which had jurisdiction over
health reform.  They found an ally in the National Federation of
Independent Businesses whose members vehemently opposed any legislation
that might increase taxes or force them to provide coverage.  Overall,
the Center for Public Integrity estimated that 650 organizations spent
at least $100 million to defeat the Clinton plan. His supporters raised
only $15 million. When the first poll was taken on President Clinton's
plan in September of 1993, 59 percent of the public were in favor.  By
June of 1994 public support had declined to only 44 percent.

Since the defeat of the Clinton plan, national health insurance has
disappeared from the political agenda.  But polls show that health care
is a leading concern of the public, second only to the Iraq war.
Still, the 2008 presidential candidates, for the most part, have been
cautious about taking a position on health care reform.  Although all
agree that universal coverage should be the goal, the devil is in the
details.  Republicans are committed to a solution that relies on
increased tax incentives to encourage people to purchase private
coverage.  Democrats favor a variety of modest measures - individual
and employer mandates, allowing people to buy into health care plans
that are similar to federal employee plans, expanding the State Health
Insurance Program for uninsured children, and increasing regulations on
insurance companies.

Given the lessons of history, candidates are understandably cautious
about advocating a program that would wipe the slate clean and truly
guarantee universal coverage.  Yet the public should demand that those
who claim they have to capacity to lead the nation take a stand on an
issue that is so critical to the well-being of every American family.
If they fail to do so, insurance companies and their allies will
continue to control the health care system and ensure that those most
in need are least able to obtain coverage.

(Ms. Quadagno is author of One Nation, Uninsured: Why the U.S. Has No
National Health Insurance (Oxford University Press, 2005)).