The New York Times
October 7, 2001
To the Editor:
While some of the disappearance of the federal surplus (front page, Oct. 1) may be attributable to slowing economic growth and the unaccountable amounts of money Congress is unquestioningly throwing at the military and intelligence complex, surely the largest factor is the huge, irresponsible Bush tax cut largely benefiting the rich that Congress passed earlier this year.
If those of us down in the valley are expected to make sacrifices for our new war on terrorism in the form of increased everyday inconveniences, more fragile civil liberties, a slowing economy and increased federal expenditures that will come out of our future Social Security and Medicare benefits, surely we can ask those living in the houses on the hill to sacrifice their newly acquired tax relief, which they didn’t need anyway.
Mark Hannay New York
Comment: Why is a letter on distributive tax policy being circulated as a quote of the day for health care reform? Mark Hannay is the Director of Metro New York Health Care for All Campaign, and an ardent supporter of health care equity. Issues of distributive tax policy are fundamental to the societal values that we must be supporting if we ever hope to inject equity into our health care system.
Prof. Donald Light responds to Gordon, Caplan, Griss and Oberlander:
Jeoffry Gordon and Art Caplan have, with somewhat different agendas, articulated well the special opportunity and need to address the long-standing, inherent inadequacies in “our lousy health care system.” Bob Griss has added still more reasons why this effort would be timely. While I agree with Jon Oberlander about the obstacles, the way around them, I think, is to get major stakeholders to sign on to a basic principle, to “simply state that every American will have access to [needed health] care.” Art is right to keep it vague, and from my international experience, the mistake would be for us experts to figure out just how. The only way around the serious obstacles that Oberlander describes is to get this basic consensus and then ask, “OK, how would you like to do it?” Then, let the small employers, the large employers, the health insurance companies, the for-profit health plans and hospitals, the public hospitals and health centers and the non-profit ones start working on an answer.
It won’t be easy, and one needs a neutral, prominent strong convenor. Let Art Caplan and the Center for Bioethics be the convenor. Bring together a hand-picked group of leaders from across the industry and sectors, close the doors, and have a sustained meeting on how to do it. Of course, it will take several such 2 or 3-day meetings. And if a plan of consensus arises, there will be subsequent back-sliding and the need to shore it up while widening the circle.
A real danger is that one group of us experts or another will oppose anything they come up with. If they go for universalizing Medicare, our experts will tell them five reasons why they’re doing it the wrong way, while the powerful pro-market coalition will tell them government-run programs always fail. If they go for a Karen Davis mix (quite interesting), nearly every faction of experts will pick apart one part or another. Advocates of a national health care program (at least, as they envision Britain’s NHS) will oppose almost anything the major stakeholders come up with. Maybe this means that in the meantime, we should have a parallel meeting to see if experts and advocates for universal health care can agree on a plan!
Aside from this recommendation, the first thing that advocates for universal health care need to do is to persuade the small employers, that fierce lobbying group that did serious damage to the Clinton proposal. On one hand, they are hurting the most (or not participating), they feel they have the most to lose, and they are the source of most workers without the partial, flawed voluntary health insurance that other employers offer. On the other hand, you can’t win without understanding their issues, taking in their value and language,and responding effectively. If we can persuade them that universal health insurance is a good deal for them, the large employers will be no problem, and together they constitute the clientele of the insurance industry, their agents and the health benefits industry.
Below are a set of REFORM RULES I circulated about two years ago and they may be helpful in thinking about strategies:
REFORM RULES FOR UNIVERSAL HEALTH CARE ACCESS (or “What is likely to Pass?”)
1. No nation has attained universal health insurance that has not built on the existing health care institutions.
Overlay or Add-on or Reconfiguration
2. Short of revolution, no universal health reform has passed over the opposition of more than one major power block.
Which one will you take on? Which one “has to go”?
What plan will gain the support of the other major power blocks? (Think of the huge battle over a few “patients’ rights.”)
3. Successful coalitions are not usually “made” but rather assembled out of existing large organized parties and groups.