Roll Call
September 19, 2002
Kennedy, Breaux To Open Big New Health Care Debate
By Morton M. Kondracke
Edward Kennedy (D-Mass.) and John Breaux (D-La.) are pushing for a new look
at comprehensive health care reform.
Kennedy, the old lion liberal, has given up on his dream of a
Canadian-style, government-run health insurance system and shortly will
introduce legislation mandating that every employer except the smallest
provide a basic insurance plan for its workers.
Breaux, who defines himself as a “radical centrist,” is working on perhaps
his most radical health reform yet – replacing the nation’s current
employer-based insurance system with an individual mandate.
The two Democrats are moving in opposite directions from a policy
standpoint, but they are acting on the same assumption – that rocketing
costs and collapsing coverage are putting the health care system into
crisis.
While Kennedy’s plan has the advantage of building on the employer system
that’s dominated health care since World War II, Breaux’s would end that
system. He’s even thinking about collapsing Medicare, Medicaid, veterans
health and other government programs into a single national insurance plan.
Kennedy’s plan:
Kennedy’s staff estimates that his plan would cover 80 percent of the
uninsured – 32 million workers and their families. Employers would bear most
of the cost, with the government subsidizing struggling small firms. No cost
figure has been worked up for the plan, but Kennedy notes that savings can
be achieved by reducing administrative and paperwork inefficiencies in the
health system, which account for $400 million of $1.4 trillion total annual
outlays.
Breaux’s plan:
People would be required to have a basic health plan much as they do auto
insurance, with better coverage optional and subsidies for the poor.
http://www.rollcall.com/pages/columns/kondracke/00/2002/kond0919.html
Comment: It is gratifying to see that our political leaders are grappling
with the problem of the uninsured. But it is disappointing to see that our
political leaders are being political. Since a single, universal program of
health insurance is still perceived as politically unachievable, attention
has been directed to the alternative approaches of employer mandates or
individual mandates.
In attempting to achieve this political “compromise,” very important health
policy principles are being abandoned. Both approaches would fall short on
universal coverage. Both would fail to achieve the administrative savings of
a universal, publicly administered program. Both would result in
multi-tiered access to care because of varying benefit and cost sharing
features in the menu of plans available. Both would fail to provide
integration of health care services that would enable more effective
application of quality improvements to our system. And both would
significantly increase the combined public and private costs of health care
for the nation.
The third option, a single, universal health insurance program, seems to be
the third rail of health care reform. But why? It would assure coverage of
comprehensive benefits for absolutely everyone, while controlling costs and
improving quality by improving allocation of our resources.
Let’s push the flawed policies over to the third rail and move on down the
main track towards an equitable, affordable health care system for all.
