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Published: February, 2007; Vol 3, Num 9

Universal Health Care – Back on Nation’s Agenda

By Mark Dempsey

“I’m baaaaaack!!!”

Health care reform, that is. A dozen years after washing its collective hands of health care reform, the government is coming back around.

And none too soon. Health care is a major concern for every American and every American business. As a proportion of the national economy, the cost of health care is doubling every twenty years or so. Today, about one in every six dollars in the U.S. is spent on health care.

When it comes to providing for your family, health care is a top priority. Who doesn’t want it? Yet, each year a greater portion of Americans do without. Currently, 46.6 million Americans lack coverage, about one in every four adults.

Twelve years ago, to much initial fanfare, President Clinton rolled out his version of health care reform, a plan crafted by a national committee chaired by his wife, now New York Senator and prospective Presidential candidate Hillary Rodham Clinton. A few weeks later, the plan was dead, tanked by a national television advertising campaign – the famous “Harry and Louise” commercials – funded by the insurance industry. Since then, no politician has wanted to take on the problem.

But the tide, now, has turned. Last spring, Massachusetts stepped into the breach with its own state-based plan to ensure health care for all its residents (see Massachusetts Spurs National Debate with Bold Health Care Initiative), and over the summer, Vermont did the same. Last month, California announced its plan for universal care, and now the federal government is coming on board. The Secretary of Health and Human Services is convening meetings among all the formerly conflicted health care interests – insurance, providers, employers and unions – and, feeling the urgency, President Bush made health care a key topic in last week’s State of the Union address.

“It is about time that health care has again arrived at the forefront of the nation’s domestic agenda,” says Armand E. Sabitoni LIUNA General Secretary-Treasurer and Labor Co-Chairman of the Laborers’ Health and Safety Fund of North America (LHSFNA). “The issue has been at the top of LIUNA’s agenda for some time. In recent years, Laborers have felt the squeeze that rising health costs are putting on us and our signatory employers. We’ve done everything we can to hold down costs, but the problem is bigger than us, bigger than the construction industry as a whole. The country has a problem, and it requires a political solution.”

Health care reform

While most Laborers enjoy some level of health coverage through their union contract, they still feel the effects of the lack of universal coverage in the United States. This is because hospitals, by law, are required to treat sick or injured patients who arrive at their doors. If the patient cannot afford to pay, the hospital has no choice but to recover its cost through higher prices to those who do pay. Because unions provide much of the insurance coverage that exists in the country, they and their signatory employers end up footing a large portion of the nation’s health care bill.

“The Laborers' Union would like to see every citizen covered because it is the right thing for all Americans,” explains Sabitoni.  “The union sector should not have to pay a penalty because it has done the right thing and insisted on coverage for its members through collective bargaining.”

Under a universal program, every citizen would be covered. This could drastically reduce overall administrative costs, especially as standardized electronic accounting and medical records systems are put in place. Also, different medical buying programs, such as purchasing medications in bulk, could produce substantial savings. Further, by establishing a minimum level of service, including preventive care, a universal program could catch health problems before they became difficult and expensive to treat, reducing the total cost of the nation’s care. These and other initiatives could help keep health care premiums in check.

However, much of the gains of universal care would accrue slowly over many years of implementation. Yet, the initial costs of creating the system and bringing the currently uninsured under some level of basic coverage are substantial. Who should pay and how is the major issue in health care reform.

If the taxpayers pay, income taxes would probably increase. Insurers might be forced to bear some of the cost, but their stockholders would suffer. If employers foot the bill, their employees, in turn, may be pinched, and some smaller businesses could fail.

Another key issue is choice. Will reform limit Americans’ ability to choose their own doctor? Will it reduce all care to some basic level or will employers, employees and unions be able to purchase a higher quality of care if they choose to do so?

After the highly polarized “debates” of the last dozen years, Americans are rightfully guarded and confused about how best to address the issues.

State trends

This is why it is probably a good thing that reform is beginning at the state, rather than the national level. The states can experiment with programs, and the real obstacles and solutions will become more clear. Eventually, a federal program to ensure universal care may result.

For now, Massachusetts is leading the way. Its program, which requires every adult to carry health insurance, takes effect July 1. Vermont’s program also begins in July and plans to insure at least 96 percent of its citizens by 2010. California Governor Arnold Schwarzenegger’s $12 billion program, to be funded by employers, hospitals and doctors, goes before the state legislature this spring.

According to Health and Human Services Secretary Mike Leavitt, 12 states have taken some recent action to broaden the availability of health insurance to all residents and more is expected.

For now, the federal government is content to expand coverage at the state level and see how this develops. “The states become laboratories,” said Rep. Frank Pallone Jr. (D-NJ), chairman of the House Energy and Commerce subcommittee on health. “Politically that’s necessary. If we tried to adopt a universal health-care plan on the federal level, we probably wouldn’t have the votes.”

Universal health care is an all-encompassing concept, with many possible ways of implementation. Those in which people pay and choose their own health care are more capitalistic and consistent with traditional American ideology. Those in which the government controls and pays for health care through taxation, as in Canada, are more socialistic and have endured considerable scorn at the hands of private health care interests.

“When it comes to health care,” said President Bush in his address last week, “the government has an obligation to care for the elderly, the disable and poor children. And we will meet those responsibilities. For all other Americans, private health insurance is the best way to meet their needs.” He proposes a system of tax credits to reward people who purchase health insurance. Many Democrats question whether that will do anything to broaden coverage. However, the other major proposal in the President’s speech – “Affordable Choice” grants for states – could help states launch their various universal care experiments in the years to come.

Given their traditions, most Americans probably agree that basic health care should be an available human right for all citizens. Most would also agree that our current system is not working. It now remains for the nation’s political leadership to sort through the ideas, the conflicting interests, the gaps in coverage and the gaps in vision to find a way to make the whole system work, and work more effectively and efficiently.