The winter holiday season is in full swing. Historically, this was a way for people to enjoy the fruits of the harvest and to prepare for the relatively more introverted, reflective months to come. In that spirit, I have a suggestion about what we might reflect on this winter.
My thoughts on this were stirred by a opinion piece in the New York Times, entitled "I Am Not a Health Reform". The piece highlighted a few facts that I think are well worth chewing over during the dark days of Winter. I'll try to add a couple of other ones.
The first fact of interest is that the type of healthcare plan currently supported by all of the current Democratic presidential candidates (except Dennis Kucinich) was actually proposed initially by Richard Nixon, the well-known friend of justice and the poor. The authers (David U. Himmelstein and Steffie Woolhandler) describe the goals of the plan (basically, to avoid harming the insurance "industry" while curbing certain specific, politically dangerous abuses), and note how unsuccessful it has been as a solution to the nation's healthcare needs, which is another point of interest. They mention specifically several applications of the Nixon plan:
In 1988, Massachusetts became the first state to pass a version of Nixon’s employer mandate — and it added an individual mandate for students and the self-employed, much as Mrs. Clinton and Mr. Edwards (but not Mr. Obama) would do today. Michael Dukakis, then the state’s governor, announced that “Massachusetts will be the first state in the country to enact universal health insurance.” But the mandate was never fully put into effect. In 1988, 494,000 people were uninsured in Massachusetts. The number had increased to 657,000 by 2006.
Oregon, in 1989, combined an employer mandate with an expansion of Medicaid and the rationing of expensive care. When the federal government granted the waivers needed to carry out the program, Gov. Barbara Roberts said, “Today our dreams of providing effective and affordable health care to all Oregonians have come true.” The number of uninsured Oregonians did not budge.
In 1992 and ’93, similar bills passed in Minnesota, Tennessee and Vermont. Minnesota’s plan called for universal coverage by July 1, 1997. Instead, by then the number of uninsured people in the state had increased by 88,000.
Tennessee’s Democratic governor, Ned McWherter, declared that “Tennessee will cover at least 95 percent of its citizens.” Yet the number of uninsured Tennesseans dipped for only two years before rising higher than ever.
Vermont’s plan, passed under Gov. Howard Dean, called for universal health care by 1995. But the number of uninsured people in the state has grown modestly since then.
The State of Washington’s 1993 law included the major planks of recent Nixon-like plans: an employer mandate, an individual mandate for the self-employed and expanded public coverage for the poor. Over the next six years, the number of uninsured people in the state rose about 35 percent, from 661,000 to 898,000.
As governor, Mitt Romney tweaked the Nixon formula in 2006 when he helped devise a second round of Massachusetts health care reform: employers in the state that do not offer health coverage face only paltry fines, but fines on uninsured individuals will escalate to about $2,000 in 2008. On signing the bill, Mr. Romney declared, “Every uninsured citizen in Massachusetts will soon have affordable health insurance.” Yet even under threat of fines, only 7 percent of the 244,000 uninsured people in the state who are required to buy unsubsidized coverage had signed up by Dec. 1. Few can afford the sky-high premiums.
Each of these reform efforts promised cost savings, but none included real cost controls. As the cost of health care soared, legislators backed off from enforcing the mandates or from financing new coverage for the poor. Just last month, Massachusetts projected that its costs for subsidized coverage may run $147 million over budget.
This is not a sterling record. In contrast, the authors point out: In 1971, New Brunswick became the last Canadian province to institute that nation’s single-payer plan. Back then, the relative merits of single-payer versus Nixon’s mandate were debatable. Almost four decades later, the debate should be over.
So, what I'm going to be ruminating over this winter is why do none of the Democratic candidates who are being taken seriously (sorry, Kuchinich supporters, but that's just how it is) seem to have the courage, intelligence, articulateness, or what have you, to cut right to the chase and advocate a true health care reform, rather than just tweaking the Nixon plan already shown not to have worked. Obviously, this won't translate into a vote for a Republican, but it really does make one wonder.
Here's another idea that might be relevant. As I blogged here, and as many others have pointed out, the bugaboo that is keeping us from a rational healthcare system is that old canard, socialized medicine. Yet, we have socialized medicine in this country already to varying degrees. If socialized medicine is defined as a single-payer, tax-supported system, with government-employed doctors and government-owned facilities, then the Veterans Administration Healthcare System is socialized medicine. Yet, the VA, although quite large, is much smaller than the entire medical system we have in this nation. As a result, it tends to fall down during periods of increased usage, such as during and immediately after large-scale or sustained combat. Why don't we break down the walls between the VA-based socialized medicine and the rest of the country? This would help not only the nation as a whole, but would also help veterans, in that they would no longer be required to go to VA medical centers or outpatient clinics in order to receive free healthcare; they could go to their local clinic, the same one their family goes to.
One more thing. I don't think that any of the Democratic candidates can do this alone; Kucinich is a good example of this. But if the candidates would caucus together, as fellow Democrats and fellow progressives, and seriously entertain the idea of promoting as a group and as a party a serious healthcare reform not based on Nixon's pandering to the insurance corporations, but based on the many long-established national healthcare plans around the world (and in the VA), then I think they could really accomplish something at last.
Happy Winter!
Greg Shenaut