Health care reform: our greatest opportunity ... ever!

Abstract

What a privilege it is assume responsibility for this column in 1993, and what a challenge it is as our nation embarks on a gut-wrenching debate over the Clinton plan for health care reform. Without the details in hand as I write this, I have an excuse if my assessment is a little weak. But the luxury of waiting is long over. I want shout my optimism from the rooftops, for I believe this plan is the most important piece of American social legislation that we will get shape in our careers. INEVITABILITY OF REFORM In the summer of 1987, I had the opportunity participate in a small health policy conference organized by the late Wilbur Cohen. Cohen spoke about how American progressivism has evolved in 30-year cycles: 1935, 1965, and, you guessed it, 1995. In 1935, we got Social Security. In 1965, despite Cohen's best personal efforts do more, America adopted Medicare and Medicaid, health care provisions restricted retirees and poor people. Cohen, a realist, understood the politics of feasibility, that half a loaf was better than none. Today, Medicare and Medicaid consume some 40 percent of all health care spending. That day in 1987 Cohen predicted, having experienced the inadequacy of piecemeal provisions and of cost shifting and two-tiered health care, that America finally be ready to complete the business of social security by adopting a national plan for universal health insurance by 1995. It's a shame that Cohen wasn't around last fall see how national sentiment about the health care crisis had crystallized during the presidential campaign. A platoon of consumer coalitions, including Health Access, Citizen Action, and Neighbor Neighbor, have been forming at the state and grassroots levels, as have professional and labor coalitions, including the Universal Health Care Action Network (UHCAN), that all support a nationwide single-payer system. Immediately after the election a crescendo of calls for reform emanated from the opponents of socialized medicine, who Cohen had fought in the past, and the very organizations who defeated universal health insurance in 1912, 1935, 1949, and 1965. One by one the American Medical Association, the Health Insurance Association of America, the American Hospital Association, the American College of Physicians, even the Pharmaceutical Manufacturers Association and the National Association of Manufacturers expressed willingness accept more government regulation, expanded benefits, and universal access care. Since then, the mass media have popularized the call for reform with an advertising and educational campaign for the hearts and minds of the American people. No one dares oppose reform directly this time. Shortly after the start of the 103rd in January, universal single-payer legislation, the American Health Security Act of 1993, was introduced simultaneously by Representatives Jim McDermott (D-WA) and John Conyers (D-MI) as H.R. 1200 and Senator Paul Wellstone (D-MN) as S. 491. The House bill now has 70 co-sponsors, and at least four other major health reform bills also have been introduced. REFORM PROCESS The challenge confronting the new president was more complicated than that facing Congress, as we can see from his economic plan. Clinton gets only one shot at developing a solid plan before tears into it. To develop an acceptable plan, one somewhere between incremental reform and a true revolution, he had put together as bold a plan as possible without alienating and the special interest groups that feed it and without getting too far removed from the concrete issues the American people understand. Although in his heart Clinton may want side with revolution, like Cohen, he is a realist. In early January, Clinton announced that Hillary Rodham Clinton head the President's Task Force on National Health Care Reform, declaring that it would work day and night until we have a plan we believe can pass the Congress (Friedman, 1993, p. …