Panel Proposes Health Clinics for U.S. Schools

A presidential council today will recommend spending $6.5 billion to provide school-based health clinics and major medical insurance for children and to guarantee that all Americans who switch jobs will be able to retain health insurance.

The advisory council also will recommend doubling the federal taxes on alcohol and tobacco and sending the money to cities and states so that they can experiment with various health care systems. One state could give a tax credit to every family to buy private health insurance, for example, while another could require employers to provide health insurance for their workers. The group stopped short, however, of proposing ways to provide comprehensive health care for all Americans.

The council’s proposals could become a key element in a long-awaited Bush Administration program for handling the politically explosive health care issue. The Administration is particularly insistent on retaining the private health insurance system and avoiding major new spending for programs.

There is no consensus in the country for how to make more dramatic changes, said Deborah Steelman, who heads the council and is expected to be a key health policy adviser during the President’s reelection campaign. “Each reform proposal pushes the cost on somebody else’s plate.”

Four of the group’s 13 members offered a strongly dissenting view, complaining that the “council has ducked the toughest issue,” by failing to propose comprehensive health coverage for all Americans. “When the flood came, Noah did not build demonstration arks,” the dissenters said in a scornful reference to the proposal for local experiments with different systems.

“Noah would not have gone out in an ark made of green wood,” responded Steelman. “This is too big an issue to be settled by five senators in a back room.”

Steelman’s group, formally called the Advisory Council on Social Security, was given the broad task in 1989 of reviewing the nation’s troubled health care system.

The council “heard clearly the voice of the people that health care reform is essential . . . but the obvious right choice for reform for one person or group is abhorrent and unacceptable to another,” according to the report to be issued today.

Without a consensus on the approach to reform, the council’s proposal for action focuses on short-term goals that could bring expanded health care to an estimated 53 million Americans.

The school-based clinics, with doctors and nurses on duty, would be open to all children up to age 22. Poor children would be treated free under Medicaid and doctor’s fees would be increased to encourage their participation. Families with incomes up to about $24,700 (about 185% of the federal poverty definition) would pay reduced rates. Parents with insurance coverage could send their children to the school clinics and pay as they would for a visit to a doctor’s office.

A special, reduced rate insurance policy would be available to cover hospital bills and other costly care for those up to age 22. With government subsidies for low-income families, the policies would cost about $25 to $50 a month for each child, Steelman said.

The council wants the subsidized program available up to age 22 because many young workers cannot get health insurance in the first few years of employment.

The plan also would expand the access to care for adults by opening 250 new community health centers; the federal government would pay the salaries of personnel and costs of installing the equipment.

The council also advocates portability for insurance coverage. Its report calls for a new federal law requiring employers with insurance to provide coverage to any new worker who had insurance at the previous job.

This would prevent employers from requiring a worker with a medical condition to wait six months or longer before becoming eligible for the firm’s insurance plan.

The proposal is designed to solve the problem of “job lock,” in which workers are afraid to quit because they might be unable to get insurance elsewhere. A survey by the council showed that 27% of workers claimed that they cannot leave their jobs for fear of losing health insurance.

The urgency of the problem was emphasized Wednesday by new reports showing an increase in the number of Americans lacking health insurance and a rise in business spending for health care.

All parties to the intensifying debate agree that the current system, in which health outlays grow at twice the rate of the general economy, is unsustainable for the long run. The nation spends 12.6% of its economic output on health care, a figure that will soar to a staggering 31.5% by the year 2020, according to the council’s estimates.

“This won’t come true--our society can’t allow it or we will bankrupt ourselves,” Steelman said.

The steadily rising costs of medical care are driving up insurance premiums, forcing more businesses to curtail or abandon coverage for workers. Individuals without coverage at work find it exceedingly hard to pay for their own policies.

The number of uninsured Americans jumped 1.3 million last year, to 34.7 million, or 13.9% of the population, it was reported Wednesday.

“A bad situation is getting worse and the poor state of the U.S. economy means that more and more people are getting thrown off the insurance rolls, “ said Sidney Wolfe of Public Citizen, which issued the report along with Physicians for a National Health Program and Harvard’s Center for National Health Program Studies. In California, 19.1% of the people were without health insurance, a figure exceeded only by the District of Columbia, Louisiana, Mississippi, Texas and New Mexico, according to the report drawn from Census Bureau data.

Businesses have been unable to slow the growth in health care spending for their workers, the U.S. Chamber of Commerce said Wednesday, releasing a survey of 1,000 firms. These employers now pay more than $4,000 a year per worker for health-related benefits.

The council’s proposals for limited changes were supported by nine of its 13 members, including Dr. Lonnie Bristow of the American Medical Assn. board of trustees; Dr. Theodore Cooper, chairman of Upjohn; Philip Briggs, vice chairman of Metropolitan Life Insurance; G. Lawrence Atkins, a lawyer and benefits expert; James R. Jones, chairman of the American Stock Exchange; John Meagher, an attorney; Arthur L. Singleton, a consultant and former congressional staff member; and Donald C. Wegmiller, president of the Health One Corp.

The dissenters were former Social Security Commissioner Robert Ball, labor expert John T. Dunlop; Karen Ignagni of the AFL-CIO, and John J. Sweeney, president of the Service Employees International Union.