Universal Health Care Issue Regaining Saliency
October 17, 2002
By JOHN A. MacDONALD, Courant Staff Writer
WASHINGTON -- Maine Rep. Scott W. Cowger was clear and concise when a newspaper asked his top priority if he is elected to a fourth term in the state legislature: "Providing affordable health care to all Mainers, not just low-income people. We must take aggressive action, including providing a single-payer universal health care system."
Cowger is not alone. With insurance premiums rising and the number of uninsured Americans increasing, candidates across the nation are reviving the issue of the uninsured. The action is most concentrated in Oregon, where voters will decide Nov. 5 whether to become the first state in the nation to cover every resident through a government-financed health care system.
Dan Isaacson, campaign manager of Health Care for All Oregon, says one statistic makes the case for the ambitious change he is trying to pass. About 423,000 Oregon residents, 13 percent of the population, are not covered by health insurance. "People have a bad taste in their mouths for health insurance companies," he said.
Still, the proposal appears to face long odds in Oregon and elsewhere. The only public poll in Oregon showed the issue trailing, 40 percent to 47 percent. The poll was conducted earlier this month by The Oregonian newspaper.
The proposal would end the system of private health insurance, which covers about 63 percent of Americans nationwide, and give the state government the responsibility for collecting taxes and paying medical bills. The goal - universal coverage - is the same one former President Clinton sought to achieve a decade ago. Clinton wanted to compel employers to provide health care, rejecting a government-financed system as exists in Canada because it was considered politically impossible.
The same conditions that prompted the Clinton proposal - multiple years of double-digit increases in health insurance costs and rising numbers of uninsured - are beginning to reappear. But that does not mean the public is ready for the kind of sweeping change proposed in Oregon and other places, experts said.
"The vast majority of Americans do not want a one-size-fits-all health insurance system," said Len Nichols, who worked on the Clinton administration's unsuccessful effort.
G. Lawrence Atkins, president of Health Policy Analysts, which advises Fortune 100 companies, said the nation's private health care system is "on the verge of a meltdown." But he is not ready to predict imminent wholesale change either.
Robert Blendon, a Harvard University expert on public attitudes on health care issues, said he sees little evidence health care is having a widespread effect on this fall's elections, largely because there has been so much focus on terrorism and a possible war with Iraq. He also doubts the appeal of the single-payer approach.
Oregon's Bold Plan
Mark Lindgren, who is working to pass the Oregon proposal, calls it an "audacious" plan. Opponents describe the proposal as an ill-conceived and ruinous tax increase.
Under the proposal, every man, woman and child in Oregon would receive health insurance with no co-payments and no deductibles. Any medical procedure approved by a doctor or registered medical professional would be covered under the plan, making it more comprehensive than most private insurance. The question is whether Oregonians would be willing to pay higher taxes to put the plan into effect.
The plan would be financed by a new payroll tax of up to 11.5 percent on businesses and an increase in personal income taxes. The top personal income tax rate would rise from its current 9 percent to as high as 17 percent. But employers and their workers no longer would pay premiums to insurers, estimated to be about $6,300 for family coverage next year.
Opponents said the plan would put Oregon's economy at risk, result in huge job losses and threaten the quality of health care in the state. One of the more remarkable figures to emerge from the debate is that the universal coverage plan would cost $19 billion in its first year, about $3 billion more than the current state budget.
The Battle Elsewhere
On a recent Saturday, hundreds of people rallied in Montpelier, Vt., for a universal health care system similar to the one proposed in Oregon. "I speak for the people of America when I say this is a lead-in for national health care," said Dr. Quentin Young, past president of Physicians for a National Health Program.
In addition to Vermont, candidates are pushing universal coverage in Maine, Washington state, California, Illinois, Massachusetts and New Mexico. This year, universal coverage proposals were introduced in at least 10 state legislatures, but all died because of tight budgets. Since 1994, single-payer system proposals have failed in Massachusetts, Florida and California.
A single-payer plan was introduced in the Connecticut legislature in 2001 but died without a hearing.
Despite repeated rejections, the idea refuses to go away. Edward F. Howard, executive vice president of the non-partisan Alliance for Health Reform, said the idea's popularity is its apparent simplicity, equity and efficiency. "It does have some appeal," Howard said.
But the appeal is far from universal. In Ohio, where prescription drug coverage is a hot item in the race for governor, the Columbus Dispatch took editorial note of the Oregon measure, commenting, "Oregon, a land where people are unafraid to take on some of the thorniest problems in health care, may become the nation's crucible once again. ... Better Oregon than Ohio."