Jul 19, 2009
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).
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
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.
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.
© 2023 Pierre Tristam
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