Not a soupcon of interest anymore in guaranteeing Americans access to medical care. A congressional majority–mostly Republican but including some Democrats–strangled the Clinton plan, then walked away. After all, their coverage is secure.
A proposal for raising the Medicare age to 67, expected next month from a commission on health-care reform. That would push many future retirees, 65 to 66, into the ranks of the uninsured. Most older people today don’t remember what it was like pre-Medicare, when health insurance was available only to a very few. When you ““go bare,’’ you risk your health, even your life.
Loss of Medicaid benefits for people removed from the welfare rolls. Among women, only one third get private insurance when they leave the rolls, says Pamela Farley Short, a professor at Pennsylvania State University at University Park. As for the rest, tough luck.
Continuing increases in the tally of the uninsured. In 1997, 43.1 million nonelderly Americans went without. That’s 18.3 percent of the population, compared with 17.3 percent in 1993 and 14.8 percent in 1987.
Around half of the uninsured work for smaller companies, says Paul Fronstin of the Employee Benefit Research Institute in Washington, D.C. You’re also vulnerable if you’re forced into early retirement (a declining proportion of firms offer coverage to their retirees) or if you’re self-employed. If you have any sort of health condition, insurers might not cover you at affordable rates.
““Almost everyone we see has a story which illustrates, sometimes tragically, the plight of the uninsured,’’ says Dr. Robert LeBow, medical director of the Terry Reilly Health Center, a community clinic in Nampa, Idaho. ““We’re talking dead mothers because they couldn’t afford prenatal care, or diabetes wildly out of control, for lack of simple medications.''
Ira regrets: For this, Ira Magaziner harbors many a regret. He was the chief architect of the Clinton plan, and thinks that–with some luck and better management–a version could have passed. ““The big corporations were behind it at the start,’’ he says. ““They saw it as a way of reducing their medical costs,’’ which had been soaring at double-digit rates. The doctors weren’t opposing it, either. ““Even the health insurers were coming in to cut deals.''
Financially, Magaziner saw a window of opportunity. The growth in health-care costs was projected to decline. Some of the savings could have been applied to universal care.
As it turned out, health-care inflation slowed even more than Magaziner expected–from 9 percent in 1990 to 2.8 percent in 1997 and a small increase in ‘98. Medicare spending eased, and a massive switch to managed care slashed corporate cost increases almost to zero. The savings flowed through to corporate profits, deficit reduction and slower gains in health-insurance premiums–all good things, but with nothing left for the uninsured.
Magaziner acknowledges some mistakes: no political heavyweight leading the team from the beginning to sell Congress on the plan; closed meetings, which failed to keep the public and press sufficiently informed; leaks of preliminary and untested budget numbers, which damaged the plan’s credibility.
But ultimately, you can’t blame the loss on the believers. As time passed and the plan lost some political momentum, the health insurers saw their chance. They quit dickering, and went for a kill.
Maybe Magaziner is kidding himself. Universal health coverage might not have passed in any form. No major social program has ever been enacted without a large Democratic majority in Congress (I’m thinking Social Security, Medicare and Medicaid). Given the advantages of incumbency, the Republicans should be able to block such an outcome for many, many years.
The forecast, then, is for rising numbers of uninsured patients with insufficient care–including, perhaps, some of the people now protected by Medicare.
Critical mass: What would put universal coverage back on the table? Maybe if the uninsured reached a critical mass, as they might in a bad recession when workers were losing jobs.
That alone wouldn’t be enough. Members of Congress care most about being re-elected, which means that health insurers can often bring them to heel by threatening to support a primary opponent or blitz the district with negative ads. No rich PACs back the uninsured. To overcome Big Money’s heavy hand, public support for universal care has to be intense.
And even then, success wouldn’t be ensured. Any plan also needs the backing of the powerful corporations that pay the majority of medical bills today. Corporations lost interest in reform in the mid-’90s, when their own costs fell. Now they may be back on the treadmill. Employer medical costs jumped an average of 6.1 percent last year, as measured by the consulting firm William M. Mercer. This year’s projection is 9 percent.
Revamping the system from the ground up could slash today’s huge and wasteful overhead (namely, the dozens of insurance-company bureaucracies). Other kinds of savings are possible, too. But employers would also seek cost relief from the government. That, plus the price of expanded care, would require federal funds.
More’s the pity, for having ““spent’’ the government’s recent health-care savings in other ways. The uninsured, with virtually no one to give them voice, limp along at the back of the pack. More of the nation’s 11 million uninsured children are going to be covered under Clinton’s kid-protection program passed in 1997. But most of the growth of the uninsured has been among adults.
Every other developed country offers universal care. We’ll get there, too, but a lot of suffering will go down first.
