Henry J. Aaron, Senior Fellow at the Brookings Institution, is among the health care gurus and Washington observers who have concluded you can’t get there from here going the Washington route.
It’s hard to argue with Aaron’s conclusion, because history is on his side. For decades, proposals for universal health care have been defeated or ignored by the United States Congress. We alone among residents of the world’s industrialized democracies refuse to provide health care security for each other.
Nevertheless, I became agitated when I read Aaron’s September testimony to the US, Senate Committee on the Budget, which, said in essence, “Let the states do it,” because you cannot do it.
Aaron, an economist who provided expert testimony when I served on the health subcommittee over 30 years ago, piled on by reviewing reasons for past failures in the November Brookings bulletin. He led with the observation we are of three minds (re legislation)--and one-third is not a majority.
He explained, “Solid and stubborn minorities favor enrolling everyone in a nationally administered system financed largely by taxes, shoring up the current employment-based system for workers and their families, or extending tax incentives to encourage individuals to buy insurance themselves. Supporters of each approach prefer the status quo to the alternatives, so doing nothing wins.” That alone may be enough, but he adds,
* Eighty-five percent of Americans are insured and fear change. (And may I observe two television actors telling untruths over coffee can play that fear.)
* Large-scale health reform is large-scale income redistribution, and the politics of redistribution is the politics of trench warfare.
* Healthcare reform involves huge financial stakes. When Clinton proposed his reform, the U.S. healthcare system spent as much as the gross domestic product of France. Now it spends as much as the combined GDPs of France and Spain.
* The U.S. political system is exquisitely structured to frustrate action on large and controversial matters on which there is not overwhelming agreement. Party discipline is an oxymoron.
* Healthcare varies greatly across the United States, making consensus hard to come by. In Texas, 24% of the population is uninsured; in three Midwestern states and Hawaii, fewer than 10% are uninsured. Massachusetts spends 70% more per person on healthcare than Utah does.
Good facts, real reasons, and I hope interesting to concerned newspaper readers. But I am more interested in how we can, just maybe, get there from here. So I circulated Aaron’s wisdom to front-line health care administrators and other valued thinkers.
Not surprisingly, the answer I liked best came from Kansas-born, Kansas-educated, personal friend Dr. Brian Biles, professor of health policy at George Washington University.
Biles has staffed Chairman Henry Waxman, Chairman Pete Stark, Senator Ted Kennedy and their respective health committees. He knows health care policy and legislation.
His response: “History shows that opponents of broader health insurance coverage seem to fight just as hard against small proposals as they do against large ones: e.g. the current S-CHIP (State Children’s Health Insurance Program) fight.
I think the only way that anything will happen is a president who will do health care in the first 9 months to get it through the Senate with a simple majority.
President Clinton did this to balance the budget rather than for health care coverage. Had he made the reverse decision, we could have close to universal coverage today.
If the economy is headed toward a recession, as some predict, people--especially women with children--will become even more anxious about their employment-based health insurance, making comprehensive legislation more likely. Brian”
Come to think of it, Henry and Brian may not be that far apart. Aaron did observe “None of this means that sweeping transformation is impossible. Seismic political events do sometimes occur.”
A recession--or some undefined “seismic political event“--is not a price anyone wants to pay. But a Bush Recession next year paradoxically could be Bush’s “gift that keeps giving” to the American people, universal health care.
Dr. Roy may be reached at email@example.com