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Window for universal health care wasted

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By MARTIN DYCKMAN, Times Associate Editor

© St. Petersburg Times
published August 18, 2002

TALLAHASSEE -- Bill Clinton's sex scandal will become a minor footnote in history, as did Thomas Jefferson's, Warren Harding's and Franklin Roosevelt's. Their fame -- or in one case, infamy -- owes to greater things. So will Clinton's. Clinton will be credited for showing that budget deficits can be turned into surplus. But that accomplishment, so casually erased by his successor, is dwarfed by Clinton's failure to establish a universal health care system.

Unless some new president can pull off a miracle, Clinton is fated to be most remembered for having squandered America's last, best chance for universal health care. The defeat in 1994, so total that he couldn't get a health bill to the floor of either house of Congress, is widely regarded as a warning that no one else should try.

This "conventional wisdom," in my view, is conventional claptrap. Clinton failed not for having dared too much but too little. The next Democratic president, if there is ever to be one, will be elected on a platform informed by the mistakes of 1994 and dedicated to the simple proposition that if every other industrial power can have universal health care, so can -- and so will -- the United States.

It would be easier, of course, for a Republican president, who wouldn't be the first of his or her party to try. But Theodore Roosevelt and Richard Nixon were liberals compared to the party's current ideology.

Clinton made many mistakes, beginning with putting someone he couldn't fire in charge of fulfilling his most important campaign promise. The plan that emerged from her secret workshop was so complex that most people couldn't understand it, which made it easy for the few who did to demonize it beyond all recognition.

That owed in large part to the worst mistake, which was in trying to cater to the commercial health insurance industry. It is as improbable to bargain successfully with it as to negotiate safe passage through a swamp full of water moccasins. The companies are just as territorial, and a lot more cunning. Remember Harry and Louise?

The Clintons should have listened to Rep. Sam Gibbons, D-Tampa, then the ranking Democrat on the House Ways and Means Committee, when he pointed out that the United States already had a nationwide health care system that was reasonably easy to understand and relatively cheap to administer. He was speaking, of course, of Medicare. Gibbons' recommendation was to expand Medicare to cover everyone.

The Clintons undoubtedly dismissed this because the cost would appear to be staggering. But it could hardly have added any more to the nation's tax bill than what is already spent for health care out of private pockets, yours and your employer's. America's total health spending topped $1.2-trillion in 2000, slightly more than half of it from private funds. Comparative figures for 1998, the last available, show our health expenditures equal to 13 percent of the domestic economy. No other country came close to that, nor would any spend anywhere near the $72-billion, including insurance rakeoffs, that it costs us to administer our system.

Despite having some 40-million uninsured people, America pays twice as much per capita for health care as France, where everyone is insured, and nearly twice as much as Germany. Are our standards of care, even for those lucky enough to have it, twice as good? Not likely. What the figures say, rather, is that universality of coverage is the secret to high-quality care at affordable prices. Requiring everyone to be in makes it possible to set a national budget and expect providers to live within it. However, government cannot expect too much for too little, as in Canada and the United Kingdom, without an erosion in quality.

A comprehensive article in last Sunday's New York Times noted that managed care succeeded for a time in restraining the cost spiral that had helped create Clinton's window of opportunity. But that gain has been lost. Double-digit premium increases returned even as recession-induced layoffs cast an estimated 2-million people off the insured rolls. A new crisis is developing; nobody can see a way out.

The states can't win this, but only the states are trying. In Florida, gubernatorial candidate Janet Reno has proposed that the state insure every child under 19 whose parents earn less than $54,000, to enroll more of their parents, and to expand Medicaid eligibility for working adults. That would help, but only modestly. Children don't cost much to insure because few of them get dangerously ill. They're more likely to lose a parent prematurely because mom or dad wasn't insured.

Meanwhile, Florida may be about to commit the lurid spectacle of amending its Constitution to protect the mental health of pregnant pigs. This bizarre act of fanaticism would also enshrine a private organization, the Humane Society of the United States, in the text of our Constitution. That $1-million could be raised for this, while the cause of universal health care for human beings goes begging, is as shameful as anything could be.

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