October 20, 2006 Volume 107 Number 20

Think again

Another losing season?

Wait ‘til next year for health care reform


I’m used to rooting for teams that start strong but never make it into the playoffs. Still, when the game is elections and my team is health care, I have a hard time adjusting to another fading finish.

Americans’ concerns about health care costs and coverage make health care reform a perennial favorite in politics. Health care tied for third in the early season Gallup poll last January, just behind Iraq and terrorism and even with corruption. By last week, however, health care failed to make the cut, as corruption moved to the top of the list.

So don’t expect to see 30-second spots about health care reform when the political ads appear between innings of the World Series. This is not our year, health care fans. But then, it’s never our year — at least not at election time.

The problem with health care as an electoral issue is that most voters don’t see a clear role for government in solving our health care crisis. If the issue were health care for seniors, i.e. changes to Medicare, those voters and their middle-aged children would be paying attention — and so would the candidates whose elections depend on their votes.

But Medicare and Medicaid cover only 25 percent of Americans. Most Americans (53 percent) earn their health care from their jobs, and a good number of those without health insurance (16 percent) look to the jobs they have or hope to have as their most likely source of health insurance in the future. They don’t think of government as a provider of health coverage and, only rarely, as a provider of health care.

So it’s hard for candidates to reach voters with proposals to lower health care costs or to expand health care coverage. Many Americans don’t think government can or should do that for them.

If soccer or hockey were our national pastime, we’d have a different view, because we’d be used to government as a guarantor and/or provider of health care. And we’d be having very different debates during our elections about controlling the costs and protecting the benefits of our health care system.

But we’re stuck in a different game here, a game whose biggest players swing their big bats against government to discourage voters from supporting reforms that can give us what most of those soccer-playing countries already have — a health care system that delivers better health at lower costs to all citizens.

We need a new playbook.

You may believe, as I do, that a system by which we earn our health coverage with our paychecks is eminently defensible in a country that prides itself on its free-market work ethic. But that system is being destroyed by employers who are abandoning it. If that abandonment continues, our paychecks will become conduits by which we pay for our own health care, which will eliminate the whole reason for employer-sponsored health care.

Given these trends, we will never get the reforms we need to achieve affordable health care for all Americans without a major intervention by government.

So what’s our next play? Do we take the path of government as regulator (with employer mandates), government as insurer (with Medicare-style programs) or government as provider (with public health clinics)?

All of these approaches make sense — for different populations. States are making headway with proposals to provide affordable health insurance for all children. The downside is that these taxpayer-financed insurance systems invariably shift more of the costs for health care from employers to working families. But that shift could be beneficial for many of those families if employers are required to support health coverage for all working adults.

Governor Ted Kulongoski has put forward a smart program to provide affordable health care coverage for all children in Oregon, combined with more school-based health centers to provide direct care. State Senators Ben Westlund and Alan Bates will soon unveil a more ambitious plan to provide health care for all Oregonians with a state-financed voucher system. And, former Governor John Kitzhaber will be right behind them with plans for reorganizing our publicly-financed health care system at the state level, including federal waivers to restructure Medicare.

We have four big hitters of our own, but each has a different strategy.

Health care has faded as an election issue again, because we haven’t coalesced around a compelling reform agenda, and we haven’t been able to overcome the skepticism that government can do anything to solve this problem.

But, unlike many other issues, health care won’t disappear after Election Day. Just wait ‘til next year. It will be right back in the top three, gnawing at the physical health and the financial well-being of a growing number Americans.

More and more commentators are talking of the need for a new political alignment in this country. That realignment could well be organized around health care. Whoever solves this problem in a way that makes government work for working people will lead a winning team in future elections.

Tim Nesbitt is former president of the Oregon AFL-CIO.