Who's A Health Care "Moderate"?
by Paul Bass
New Haven Independent
December 10, 2008
Who’s a health care moderate? And what would “Give ‘Em Hell” Harry Truman say today?
Those questions — from health care debates past and present — emerged Wednesday from a presentation at the Greater New Haven Chamber of Commerce’s 2009 Regional Economic Outlook Breakfast at the Lawn Club.
The presentation was made by Martha Wofford, Northeast manager for Aetna’s Consumer Segment.
She filled in hundreds of local businessfolk on where the current political battle over health care reform stands. She made the presentation at a time when activists and politicians from President-Elect Barack Obama on down are promising to overhaul a broken system at both the state and federal levels.
The main new reform plan being advanced in Connecticut was unveiled this week by the Universal Health Care Foundation. It calls for an end to insurers denying coverage based on pre-existing conditions, and limits the size of deductibles and co-pays, among other changes. A centerpiece of the plan is expanding the state employees’ health plan to include people who work for themselves, for not-for-profits, for local governments, or for small businesses. (Click here and here for details.)
By Wofford’s account, “extreme left”ists are pushing government-paid health coverage for all. “Conservatives” consider any government involvement in health care “bad.” Meanwhile “most Americans” — and her insurance company — are the sensible “moderates” working toward a solution to cover at least some of the nation’s 45.7 million uninsured people, with some government help.
Wofford’s presentation began with a mystery quote. Who, she asked the Chamber members in the crowd, said the following?
“Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”
Wofford revealed the answer at the end of her talk: President Harry S. Truman.
Afterward, she said used the quotation for inspiration, to set the tone for her remarks. She said she wanted “to show that health care has been a challenging issue since 1945.”
The quotation came from a Nov. 19, 1945 speech in which Truman advocated a national government-sponsored universal health care system. Here’s the speech.
She said she didn’t know a lot about the health care plan Harry S. Truman pushed at the time. It was a universal health care plan. Government-run. Business interests like General Motors killed it by arguing that Americans don’t trust government to run health care. They argued that private interests do it better — private insurers, and private companies that offer the insurance plans to employees. Six decades later, companies like GM are struggling to stave off bankruptcy in part because of out-of-control health care costs.
Road Map
Harry Truman would have shown up at one extreme of the ideological road map Wofford presented Wednesday morning. (It’s pictured at the top of this story.)
She divided three main approaches to health care into three camps. On the left was a column headlined “liberal.” In her remarks, she referred to people espousing the positions there as the “far left.”
These people see health care “coverage as a right.” In their view, the “private sector creates market failures.” So they support expanded “government-based solutions” like a “single payer system.” Their mantra: “Regulation is Good.”
At the other end of Wofford’s spectrum are “Conservatives” like the McCain presidential campaign. They see health care “coverage as a commodity.” They trust in “free market,” “private sector solutions,” with a “lean” role for government. Their mantra: “Regulation is Bad.”
In the center? The “moderates.” That’s most of us. And Wofford’s employer. “The American people are right in the middle,” she said. “Aetna is also in the middle.”
This group advocates a “reasonable” public role in health care. It sees universal coverage as a “goal” to work toward. It supports solutions based on “public-private partnerships,” government working in tandem with insurers and employers.
Wofford pointed out that 85 percent of Americans do have health insurance. Most of them get insurance through employers. She argued that the employer-based system works best and should stay in place. She advocated a “pay of play” system for employers, encouraging them to offer employees insurance, fining them if they don’t.
The 15 percent of the country without insurance needs attention, in a variety of ways, she argued.
Of the 45.7 million uninsured, she reported, 11 million are eligible for Medicaid, but are not enrolled. So part of the solution is to figure out how to enroll them. She favors a Massachusetts-style mandate on individuals to have health insurance, the way the law requires that drivers have car insurance.
Another 9.7 million of the uninsured aren’t U.S. citizens, she said. Many of them are here legally, but could use help being plugged into the system.
More than 9 million uninsured adults have annual incomes above $75,000, according to Wofford. That means any health care solution needs to look at controlling spiraling health costs so those people can afford to buy in, she said.
The remaining 13 to 16 million people “need a government plan,” she said.
A Peer Review
Reviewing Wofford’s PowerPoint later on Wednesday, a Yale health care policy historian called the presentation “a desperate attempt to protect and preserve a failed for-profit market for health insurance.” One that benefits private insurers like Aetna.
Harry Truman would be aghast, in the view of the historian, history professor Jennifer Klein. Klein (pictured) wrote the 2003 prize-winning book For All These Rights, which detailed the development of the American system of employer-based health insurance and pension benefits.
Klein said that the presentation left out a key reason so many people can’t afford or find health care: “the for-profit imperatives in the whole system.”
“We’ve had over five decades to see how the commercial insurance market works as
the key means of providing health care access,” Klein said. “The bottom line is that in all that time health care has gotten neither more affordable nor more accessible. Numerous policy fixes have been applied to goad the private health insurance system toward universality or to rein in costs. As we can see, these goals are no more within reach than they were 20 or 30 years ago.”
She added that Wofford’s statistic about the prevalence of employer-offered health insurance is outdated. Employers are raising premiums or eliminating coverage by the day — and in the recession laying off employees en masse.
“The employer providing coverage is a system that’s on the decline. It peaked in the late 1970s,” Klein said.
Harry Truman did in fact propose a “government-run” single-payer plan, Klein said. People often confuse such “government-run” proposals with nationalized medical systems, she said.
“Truman believed in expanding social security to include a universal health plan. He wanted to amend the Social Security Act to include national health insurance. Government would replace private insurance companies,” Klein said.
“You have to be careful about ‘government run.’ People think that means hospitals are government hospitals, and doctors are government doctors. [Rather] it was about the insurance mechanism. It was about the financing.”
Truman would have landed in the blue left-hand column of Wofford’s chart, Klein said. “As he saw it, offering national health insurance was a way of delivering on the New Deal.”