^{Posted on March 23, 2007}

Winds of change carrying cries for health care toward the Hill

Lance Dickie
Seattle Times | Editorial Columnist
Friday, March 23, 2007

Here is an unadorned fact of political life: An anxious middle class makes things happen, which explains the persistent drum beat of national interest in universal health-insurance coverage. People are uneasy.

The exact shape of the change to come is not clear, but more and more Americans are eager to listen to the options. One of the most straight-forward, and familiar, is national single-payer health insurance.

Everyone keeps their own doctors. Or more to the point, everybody can have one. Health care via physicians, nurses, hospitals, clinics, tests and technicians does not change. The caregivers are not employed by Uncle Sam.

Instead of having private insurance, everyone pays something into a common fund, and government writes the checks. Maybe it is the federal government that pays the bills, or states could be given the cash to devise a payment system that works best closest to home.

The revolution is in financing and reimbursement, not health-care delivery.

All the more curious is this uneasy mood occurring in what are understood to be recession-free, stable economic times of low unemployment.

Not long ago, the observation that unpaid medical bills are the No. 1 cause of personal bankruptcy might have been mildly interesting, like the unemployment rate if you have a steady job. Instead there is an unsettling recognition of vulnerability.

The middle class watches as medical benefits are cut as they grow more expensive or are lost altogether. Parents worry about grown children going without insurance because of the cost or employers who do not provide it.

Two short generations out from broad employer-based coverage, grandchildren come into the world without the neo-natal talisman of economic stability, a health-insurance card.

Two things are happening. In huge numbers, voters — a key word — are telling pollsters they think the federal government should guarantee health insurance. They are willing to pay higher taxes and forego tax cuts for the coverage, according to a recent New York Times/CBS News Poll.

Politicians hear the rumblings, and they are reacting in state capitals and on Capitol Hill with ideas and plans, many of which have been around a while. The stunning reversal of fortune for Congressional Republicans helped with the sensitivity training.

Last Friday on an unseasonably balmy evening, 300 people were in Kane Hall on the University of Washington campus to offer a rock-star welcome to three leaders working to provide universal health care. Given the topic and the weather, it was like packing Key Arena.

Rep. Jim McDermott, D-Seattle, and Dr. Quentin Young, co-founder of the Chicago-based Physicians for a National Health Program, have seen the political climate and national conversation turn in their direction. At the heart of both their optimistic talks was the need for public education.

Young, a wise-cracking octogenarian praised as a policy bulldog, works to keep the essence of single-payer simple. Repeat after him: Everybody in. Nobody out.

McDermott is equally tenacious. He first introduced his single-payer legislation in 1992. Bloodied but unbowed by the health-care debacle of the Clinton years, McDermott sees versions of his federal bill sprout in legislatures around the country. In a telephone call this week, McDermott said he sees the activity in the states as part of a welcome ferment that will help drive action at the national level.

The other significant change in the dynamic for universal health care is the interest being shown by major employers and labor unions. Over time, he expects state efforts and business support to point toward a single universal national plan.

Rep. Sherry Appleton, D-Poulsbo, was given an award by the Northwest chapter of Young’s group, for her work on The Washington Health Security Trust, which is dead for this session. A good idea, it will be back. Washington has 643,000 people without health insurance, 15 percent of the 43 million Americans without any coverage. Millions more have inadequate insurance.

State by state or via Washington, D.C., anxious Americans are demanding change. In this atmosphere, no credible presidential candidate can afford to be without a coherent health-insurance plan.

Lance Dickie’s column appears regularly on editorial pages of The Times. His e-mail address is ldickie@seattletimes.com