Striving for universal health care

Posted: Monday, August 06, 2007

WASHINGTON - Since almost everyone in Washington knows that members of Congress and their staffs have some of the best health insurance in town, you can imagine the surprise that greeted freshman Rep. Steve Kagen when he said he didn't want any.

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Until every American has decent health care, he declared, he won't take any for himself.

"I didn't run for Congress to get health care benefits," the Appleton, Wis., Democrat recalled telling the woman who enrolled freshman congressmen. "I came to try to get health care for the people back home in my district and across the rest of America."

In case you're wondering, Kagen can afford to go without health insurance more easily than most of the rest of us can. He's a doctor. His wife is covered at her job, he says, and their kids are grown and have their own coverage elsewhere.

But the real issue, he points out, is not his coverage. It's everyone else's.

"If every congressman had to go to bed hungry, we'd solve the hunger problem," he said. "We need to work just as hard to solve the health care problem."

I wish him well. He has the admirable zeal of many first-year congressmen - before they run into the long, hard second-year slog of campaigning for re-election.

For now, as health care rises in importance as a political issue, Kagen embodies the latest generation of advocates to take on the crusade for universal coverage, a crusade that is fought these days in many smaller battles.

As we spoke last week, for example, the House of Representatives had just voted to triple the funding for the 10-year-old State Children's Health Insurance Program, known as SCHIP, for low-income children.

Since SCHIP was enacted, the percentage of uninsured children in the United States has dropped to 16.9 percent in 2005 from 22.5 percent, according to the Congressional Budget Office, an independent government agency. That leaves about 9 million children without coverage. About 6 million of them would qualify for SCHIP under the House bill, which would add $50 billion to the program, although it has to be reconciled with a more modest Senate version that would add $35 billion.

Yet no matter how they are reconciled, President Bush has threatened to veto it. He denounces the SCHIP expansion as a sneaky attempt by Democrats to replace private insurance with "government-run healthcare."

That argument makes me chuckle. The words "government-run healthcare" are supposed to send shivers down our spines, as if it were something horrible and foreign - perhaps even French!

In fact, we Americans already have a government-provided health insurance that has worked remarkably well and remains remarkably popular. It is called Medicare. It's not perfect, but its approval ratings are a lot higher than those of most politicians.

Unfortunately Medicare is only for seniors. That doesn't help the estimated 45 million others who don't have coverage - or the millions of others who don't find out until the brink of bankruptcy that they and their families are not as well-covered as they thought they were.

Kagen knows. Give him a few minutes and the allergy specialist will tell you one story after another about patients who were not following his prescriptions simply because they could not afford the medication. He ran for Congress, he says, so Americans would no longer have to choose between buying their next pill or buying their next meal.

Yet he's not a socialist. He likes free markets. He campaigned on a short list of ideas that would "allow everyone to benefit from the efficient delivery of affordable care in a transparent and competitive marketplace."

They include "open disclosure of all health-care related prices." When we health care consumers ask our providers for the real price of a procedure, we may well be answered with: "What insurance do you have?" Cost controls begin with competition, which begins with the ability of consumers to shop around.

He'd also like to see "unitary pricing," meaning the uninsured should receive the same discounts for health care products and services that the insured often receive now.

He'd like to see a "single national insurance risk pool." For example, government and the insurance industry could pull together a generic insurance policy that would cover everyone without exclusions for pre-existing medical conditions. No one would be forced to choose it, but it would give us all something to which we can compare other policies that insurance companies offer.

Deductibles should not exceed 3 percent of a household's taxable federal income, Kagen says.

And, finally, he would like to see a "renewed commitment to cover all uninsured children and working parents."

That's the big prize on which Congress needs to keep its eyes. In the meantime, Kagen raises important ideas for short-term reforms. They don't attack the free market. They just try to make it work better.

• Clarence Page can be contacted at cpage@tribune.com.



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