May 26, 2018
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Health After Daschle

This is no time to delay starting a major reform of America’s broken-down, inefficient and exorbitant health care system. Tom Daschle looked like the ideal point man, but he’s gone and nobody is irreplaceable. Right now, the need is urgent and the opportunity is here.

Urgency? Costs of health care are zooming upward, threatening economic recovery plans now and in years to come. And escalating unemployment adds daily to the ranks of the insured and underinsured.

Opportunity? Prospects for universal health care are better than when earlier attempts failed. More people are hurting and demanding change, as many lose their insurance through layoffs or employers’ cutbacks and runaway medical debt causes personal bankruptcies. One-third of nonelderly adults are underinsured, and they are not just the poor; their median income is $58,000. Doctors and business urge reform, the American Medical Association is pushing universal health care, and the National Association of Manufacturers is focusing on cost containment.

Past reform efforts failed largely through fear of “socialized medicine” fostered by the AMA, the insurance and drug industries and conservative business groups. The Clinton administration failure is often blamed on the “Harry and Louise” advertising campaign featuring a couple that hated and ridiculed the plan. More important were its mammoth size and complexity and the fact that it was radically new rather than building on popular programs like Medicare and Medicaid. People still holding employer-based health insurance feared that a new and unproven system would be worse.

As put by Jacob S. Hacker, author of the recent paperback “Health at Risk,” the 1,342-page Clinton plan “was an already crippled creature dropped into the den of wolves that America’s uiltraexpensive medical complex had spawned” and ended up “friendless, misunderstood, and shunned by the very middle-class Americans whose plight had prompted the effort.”

So, as Mr. Daschle understood, and as his successor must grasp, the new plan must steer a middle course, avoiding conservative and liberal extremes. Conservatives would rely on unregulated markets in medicine and pharmaceuticals, which has already failed. Liberals dream of breaking off the connection between employment and health insurance and achieving a single-payer plan like those of most leading industrialized countries.

True enough, the employer-based health insurance is breaking down, as managers cut back coverage and benefits or discontinue them altogether. But abruptly abandoning that system could doom a new plan.

The Obama administration plan should not risk an abrupt proposal for a single-payer system. When considering family economics when faced with illness or injury, universal single-payer health care would be the most obvious solution, said a recent essay, “Get Sick, Go Broke,” co-written by Elizabeth Warren, a Harvard law professor who now heads a congressional oversight panel on the bailout program. If single-payer is unacceptable, they wrote, another option would be guaranteed access to affordable and adequate health insurance.

What we need is a moderate, understandable, unthreatening plan that will eventually save billions and help economic recovery.

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