To be sure, Democratic elders in the Senate have unveiled a sweeping bill that would extend health insurance to all Americans, including the more than 34 million who now have no coverage at all. And administration spokesmen, pleading for action, have warned that health-care costs will soak up 37 percent of the gross national product by the year 2030 if nothing is done to slow them down. But the Democratic bill can’t pass without George Bush’s support, and Bush is waiting for it to be shot down before he comes in with his own measure calling on state and local governments to find ways to cut medical costs. And while both parties hope to use health as an issue in next year’s campaign, neither wants to pay the political price of dealing with it before the election. “It’s the scariest politics of all,” says Republican consultant Mike Murphy, “because there’s no easy answer.”
Worst off are the uninsured. But there’s no national will to help the have-nots, so Democrats who have long championed national health insurance to bring them into the tent are now trying instead to mobilize middle-class support. That means enlisting the 200 million Americans who have insurance but find it a bureaucratic nightmare or fear it may let them down in a real emergency. Once a week, West Virginia Democrat Bob Wise gives a one-minute speech on the House floor, telling a medical horror story: about a 2-year-old with cerebral palsy, for instance, who can’t get therapy because his father’s insurance plan doesn’t cover pre-existing conditions, or a teenager with hemophilia whose father’s insurance premiums have risen to $900 a month. “I’m putting faces in front of the statistics,” Wise explains. “And I’m trying to puncture the myth that health is a problem of the poor and indigent.”
The tactic is working. “It’s becoming a middle-class issue because that’s who’s getting scared,” says Ellen Goldstein, a private-pension lobbyist. But it works only up to a point: poll after poll shows that while voters consider health care a birthright, they are not willing to pay for it. “People want to hear about health care,” Murphy explains, “but they don’t like any of the messages - that it’ll cost more or that doctors make too much money. There’s no real applause line.” Worse, any solution gores at least one big ox: doctors, hospitals, insurance companies, labor and big business all have their own angles on the issue. Lawmakers still flinch at the memory of the rebellion of the affluent elders two years ago when retirees were asked to pay part of the cost of catastrophic health care.
For all those hazards, lawmakers headed by Sen. Ted Kennedy have worked for two decades to pass a national-health bill. They have recruits these days in a band of younger legislators who sense the power of the issue. But it’s a measure of the times that the Democratic bill proposed this month is remarkably similar to one that Kennedy scorned as inadequate when Richard Nixon offered it in 1971. The measure would force all U.S. businesses to “play or pay,” either enrolling their employees in health insurance plans or paying into an “AmeriCare” fund that would buy insurance for all Americans not enrolled in business plans. The scheme started as a bipartisan measure and still has a surprising amount of qualified support from interest groups, including the National Association of Manufacturers. It would cost $6 billion in its first year, with funding largely unspecified, but its sponsors maintain it would save $78 billion in national health costs over five years.
For his part, George Bush made a campaign promise in 1988 to provide “access to health care for all Americans,” and he has assigned Louis Sullivan, secretary of health and human services, to head a task force on how to do it. Sullivan, who says he’s “a doctor first and a politician second,” is eager to move. But when he went to the White House recently to report progress, he was told not to rush. The task force isn’t expected to report for at least six months.
Sullivan is at odds with chief of staff John Sununu, whose polls show that health care is only the number-four priority for voters. Sununu argues that it’s even less important to affluent Republicans, so why should Bush risk anything before he has to? “It’s just too hot,” says one of his aides. And Bush himself tends to side with Sununu, taking a minimalist approach in the belief that there’s little the government can do in any case. As with other domestic matters, the president wants to throw the hot potato back to state and local officials.
So, while stalling on Sullivan’s report, the White House strategy is to drop minor bills into the vacuum. Bush has already proposed a medical-malpractice reform, asking states to limit jury awards to $250,000 for pain and suffering and provide mediation for malpractice disputes. And he announced last week that he will ask Congress for $40 million next year for vaccines and clinics to immunize poor, inner-city children. “The idea is to make it look like we are tackling the health-care problem,” says a disgruntled senior administration aide. “The reality is, we are avoiding it.”
How the issue will play in political reality is anybody’s guess. For West Virginia Sen. John D. (Jay) Rockefeller, sponsorship of the Democratic bill is a high-stakes gamble that could make or break his presidential hopes. Other Democrats, like Texas Sen. Lloyd Bentsen, worry about the bill’s cost to small businesses. Republicans are quick to underscore that: Senate Minority Leader Bob Dole said the bill’s sponsors are “looking for a new pocket to pick, and small business will fill that role.” In the end, it will depend on how much fear of ruin Bob Wise and his colleagues can drum up. If the issue remains number four on Sununu’s charts, the president has probably won his bet.
Climbing medical charges are pricing many Americans out of the health-care market.
The U.S. spent $671 billion on health care in 1990, twice the amount spent eight years ago.
Canada’s national health-care system spent $1,683 per capita in 1989 (9 percent of GNP); the U.S. spent $2,354 (12 percent of GNP).
More than 34 million Americans have no health insurance.
Of the uninsured, 85 percent are employed. About 27 percent of Hispanics are uninsured, 20 percent of blacks and 12 percent of whites.
By one estimate, the U.S. will have 140,000 more physicians by the year 2000 than in 1986, adding $40 billion to the nation’s health bill.
