Rx for Universal Care

Rob Phillips and his girlfriend Heather Fay were on their way to the Long Beach Airport when their little black Honda smashed into what became a 216-car pileup on the 710 Freeway. Miraculously, no one was killed that foggy Sunday morning, but Phillips, a cashier at Wild Oats in Pasadena, and Fay, an aspiring filmmaker-cum-waitress, were among 100 people injured. A Times story on Christmas Eve documented the young couple’s struggle since the Nov. 3 accident to mend physically, emotionally -- and financially.

Their recovery has been challenging enough without the added pressure of $36,000 in hospital bills and no medical insurance to pay them. One in five Californians is one car accident or one heart attack away from just such a financial disaster -- or worse. Since the Clinton administration’s plan crashed in the early ‘90s, comprehensive, nationwide reforms that would expand coverage to the millions of Americans without health insurance have gone nowhere. Today a handful of California legislators support state reforms. Employer groups are banding together to expand coverage and keep costs down. This month, insurance executive Bruce Bodaken, who heads Blue Shield of California, entered the debate with a proposal he calls “universal coverage, universal responsibility.”

Rather than replacing the current system of employer-sponsored health insurance that covers about 60% of Californians (Phillips had been days away from signing up for such coverage), Bodaken’s plan would build on it. To cover the 6.3 million Californians without employer-sponsored insurance, his proposal knits together a number of reform models, some considered conservative, others more liberal. He would make insurance mandatory so that the healthy pay their share, which some Republicans favor, and require all but the smallest employers to either offer it or contribute to a state insurance pool. He calls for a greater effort to sign up the 30% of the uninsured who already qualify for some type of government help but aren’t enrolled -- a challenge that will no doubt have to wait until California climbs out of its $34-billion debt hole.

Some critics say the new plan is self-serving since it would increase business for Blue Shield and other insurers. Longtime universal-care advocates would prefer to scrap the entire system, tax everyone with an income and have the government be the “single payer” for health care, as it is now for Medicare and Medicaid. But they have failed to gain the support needed for such an overhaul, even in good times.

The first step toward universal care must include a public effort to establish a floor and a ceiling for which services should be covered.

As distasteful as the idea of “rationing” is to many people, universal-care advocates are right to assert that it goes on every day, depending on money and luck. And whether Bodaken’s plan is right for California or not, it helps move the debate on universal care into a fully mainstream arena.