Rep. Dick Gephardt, one of the contenders for the Democratic presidential nomination, announced a plan for providing health insurance to most -- not quite all -- of the 41 million Americans not currently covered by either private or government sponsored plans. These people are, for the most part, lower middle class -&endash; too affluent for Medicaid, too poor for private plans and too young (or healthy) for Medicare. If there ever was a silent majority, or even a silent plurality, this is it.
Gephardt's proposal has major flaws. It's modeled in large part on the Clinton proposal that was extremely cumbersome &endash;- but the flaws were and are intended to rally support for the program from the private insurance companies, who would stand to pick up business from the new enrollees and would move heaven and earth to prevent a single-payer health plan. The money would come from rolling back the Bush tax cuts, and using the money to subsidize employers who provide insurance coverage to workers who currently have no coverage. The plan would only provide funding for about 60% of the expense of providing insurance, but the money would be in the form of a tax credit rather than as a deduction. It's not the best plan, but it tries to avoid the political opposition that toppled the Clinton proposal, and in most ways it succeeds. The Hannibal (Mo.) Courier-Post quoted Gephardt as saying: "I can get business for this, I can get labor for it, I can get the health care industry for it -- that's a potent combination ... I can pass this bill and we can finally say we've got everybody in this country covered with quality health insurance."
Gov. Howard Dean has also proposed a plan for universal coverage, similar in many respects to Rep. Gephardt's, but the Dean plan has gotten less public attention. Either plan, in fact any plan for universal coverage, would offer major benefits to not only individuals, but also to corporations and the economy as a whole. Many experts would prefer a single-payer plan as the most efficient design for health distribution, but Japan has functioned well with a system of government and private insurance plans. With proper design, there's no reason the Japanese model of health care can't be imported as successfully as Japanese cars.
The advantage of universal coverage is that it can, with any sort of proper design, eliminate much of the administrative workload that our current system requires. By making medical care available to more people, some diseases can be controlled at an early stage, instead of developing into catastrophic conditions.
The US currently pays twice as much, as a percentage of its gross domestic product (that's the national economy) and in dollars as any other developed nation. In Japan (where, according to a 1998 report, over 55% of the men are heavy smokers), an infant can anticipate a health life span (the number of years lived before disease or disability destroy the quality of life) of 73.6 years. The best the US can do is 67.6 years. France, fois gras and all, has a healthy life expectancy of 71.3 years. Australia 71.3 years, Canada 69.9.
While the Bush administration has devoted itself to a domestic policy program that reproduces failed experiments, from the Reagan experience with self-financing tax cuts to the California study on medical malpractice reform, we haven't tried the one program that has been shown to reduce costs over most of the civilized world. The nations with longer healthy life expectancies than the US pay about 6-7% of their GDP for health costs, while we pay about 15%, and still leave 41 million people without basic insurance.
When the World Health Organization rated the efficiency of health distribution systems for 191 nations, the United States came in 37th, just behind Costa Rica, and in a statistical dead heat with Slovenia. In a review of infant mortality rates of 29 nations, we were in 23rd place.
President Bush has repeatedly cited John Maynard Keynes as the inspiration for his "economic stimulus package," in other words, his tax cuts for the rich, claiming that in tough times it's appropriate to run a deficit. Keynes never said that. The point Keynes made in The General Theory of Employment, Interest and Money is that in order to prime the economic pump, money has to be put into circulation. Offering more money to those who already have too much doesn't help, just as lowering interest rates to businesses, as the Federal Reserve has done, doesn't stimulate investment in new factories when there's already excess capacity. The only thing that can do that is an increase in demand, and that requires having more people able and willing to buy products.
Universal health care would lower the costs of care for millions of people, distributing the money more equitably and efficiently than through tax cuts for just a few. By covering the uninsured, it would increase the number of consumers of health resources, leading to more jobs in the health professions and trades -&endash; creating more consumers of other products as well. If the cost of universal health care follows the pattern seen in every other developed nation, national expenses for health care would drop by 33% to 50%. That money could be used for other social priorities, like decent schools, affordable college educations, and affordable housing.
Universal health care offers benefits for everybody, even the rich, who might lose their tax cuts, but would profit most from the revitalization of the economy. The only thing standing in the way is the American paradox: those who would benefit most from an active government have lost faith, and don't vote; while those who want to reduce the size of government are the most politically active. More than ever, turning this pattern around is a matter of life and death.
Sam Uretsky is a pharmacist living on Long Island, N.Y.