The Politics of Health Care

Though U.S. law guarantees that National Guard troops and active-duty reservists will have jobs to come back to, it doesn’t require employers to keep providing health insurance. All their families get is a stripped-down federal program called Tricare, so stingy and bureaucratic that most doctors and hospitals won’t accept it.

The reservists’ families are a sympathetic cause, and of course Congress will fix their plight, either offering another plan or raising Tricare’s reimbursement. But the bigger problem remains: The United States spends 14% of its gross domestic product on health care and leaves about 40 million people uninsured. Germany spends 10%, while providing health care to all. The cost of U.S. managed care increased 12.7% last year, the highest jump in a decade, leading some employers to drop coverage. States including California are cutting or planning to cut public health-care programs to contain deficits.

Health-care gridlock has the attention of politicians and business leaders alike, but politics still drives the debate. Leading would-be Democratic presidential candidates pound on the stinginess of President Bush’s tax credit proposals for helping the uninsured poor. Republicans scoff at the cost of Democratic alternatives.

If Congress could focus on solutions, a starting point would be a proposal by Sen. John B. Breaux (D-La.). Breaux, a firm centrist, would guarantee all Americans access to basic insurance with help through federal tax credits for low- and middle-income people. Each state would be required to oversee costs and quality. A debate on Breaux’s bill would at least provide voters with a better understanding of what might be lost to huge new permanent tax cuts. What’s also needed are more honest voices like that of Sen. Susan Collins (R-Maine), who last month told the Washington Post: “My brother, a conservative small businessman, is saying maybe it’s time for the government to take over health insurance.... [B]usinesspeople for the first time are questioning whether private health insurance can survive.”

States are waking to the depth of the problem, but in California, employers say that unless they are allowed to trim benefits, they will be driven out of business by workers’ compensation fees, a family leave requirement and a minimum wage increase.

Assemblywoman Rebecca Cohn (D-Saratoga) proposes a modest compromise that would allow employers to offer an “essential benefits plan,” something forbidden under current state law. Cohn has not defined “essential,” but the idea is to start a public discussion along the lines of Oregon’s debate, which led to medical authorities, not HMO bean counters, specifying a standard basic benefit package that is universally available.

Breaux has a good idea. So does Cohn. But the uninsured will probably have to pray for good health until at least after the next presidential election, unless a rash of selfless public service breaks out in Sacramento and Washington.