Here's a good way to celebrate the 40th anniversary of the Moon landing: Exceed that achievement with one of greater value. Going to Mars would be nice. Getting universal health care would be cheaper. It would do more good to millions of people than expeditions to outer worlds to pick up rocks and plant flags. It should also be easier. Yet we put a man on the moon within eight years of setting the goal but haven't managed to bring about a civilized health system in six decades of trying. Maybe 2009 will be different. To the nation's credit, health reform is holding its own against other circuses (Michael Jackson, Sonya Sotomayor, moonshot nostalgia), though it remains a Bataan march through the good, the bad and the ugly.
The good: I'd say odds are 60-40 (a familiar number these days) that reform will make it through Congress this year. Detractors don't have Hillary Clinton to kick around like they did in 1994. Democrats have been clever to keep their proposals unimaginative. They pander to private insurers by sticking with the majority of the present system. They lean on employers to pick up a modestly larger tab either by covering more employees or contributing a minute percentage of operating costs to a federal insurance fund that will. The cost of the program, $1 trillion over 10 years, is still cheaper than fighting useless wars and possibly less deadly (insurgents having nothing on private insurers and hospital infections).
Single-payer would have been cheaper, more effective and more fair. It would end the insurance cartel's chokehold on patient choice and its arbitrary gradations of covered and uncovered procedures, which defeats the purpose of insurance. But maybe it's time to quit dreaming and submit to progress by increments and illusions.
The bad: They call it universal care. It's not quite that. The Congressional Budget Office's best-case scenario sees the number of uninsured reduced by 37 million by decade's end, leaving 17 million uninsured. The non-partisan CBO also says that the plan won't lower costs as advertised. How could it? Its underlying premise -- public-sector insurance competing with private insurers -- leaves untouched the dysfunction at the heart of the system: For-profit insurers make double-digit profits by minimizing benefits and eligibility while maximizing premiums. The plan doesn't change that. It feeds it.
Worse, to offset some of the costs of the health care overhaul, Democrats are proposing to add a surtax of 2 to 5.4 percent on the "wealthiest Americans" by 2013 (individuals making $280,000 and up and families making $350,000 and up). I'm all for progressive taxation. But this is sheer opportunism. Universal health care is a universal responsibility. To be successful politically and economically, everyone should have a stake in it. We all pay for Medicare, even though some of us will never make it to Medicare age. We should all pay for universal care, especially since all of us need health care regardless of age. If families making more than $1 million a year should pay a 5.4 percent income surtax, why not at least reduce or reverse fractions of the tax cuts going to the under-$250,000 set? Since when is an individual making $100,000 not wealthy? I make far less than that but would happily trade my insurance premiums for twice the equivalent payroll tax if truly universal care were the result.
The ugly: I was digging up old newspaper clips about the Moon landing the other day and there, on the back of a July 17, 1994 New York Times commemoration of the landing, was a special report on the "advertising blitzkrieg" over Bill Clinton's attempt to reform health care. The report quoted a television ad opposing the plan. "Announcer: A lot of politicians promise health reform. What would it mean to you and your family? What most politicians are promising would mean a big bureaucracy. Loss of jobs. Waiting lines. Limiting your right to choose doctors. Rationed medical care."
The same scripts, the same old lies, are being recycled today. Dollar for dollar, the best insurance systems are government-run -- Medicare, Medicaid, S-Chip (the children's insurance program). With some state exceptions (Florida's Medicaid system is particularly stingy) they provide more access and better care at lower costs than most private and employee-provided insurance, mine included. The models are in place to establish a fantastic universal care system.
Between lies and timidity, that's not where we're headed. As vision goes, the Democrats' version of reform is the equivalent of the International Space Station -- a low-orbit clunker imprisoned by old-world gravity and make-work objectives. Health care's moon shot still awaits.