[Marxism] Democrats recycle Nixon "health plan"

[Louis Proyect <lnp3@xxxxxxxxx>]

NY Times, December 15, 2007
Op-Ed Contributors
I Am Not a Health Reform
By DAVID U. HIMMELSTEIN and STEFFIE WOOLHANDLER

Cambridge, Mass.

IN 1971, President Nixon sought to forestall single-payer national 
health insurance by proposing an alternative. He wanted to combine a 
mandate, which would require that employers cover their workers, with a 
Medicaid-like program for poor families, which all Americans would be 
able to join by paying sliding-scale premiums based on their income.

Nixon’s plan, though never passed, refuses to stay dead. Now Hillary 
Clinton, John Edwards and Barack Obama all propose Nixon-like reforms. 
Their plans resemble measures that were passed and then failed in 
several states over the past two decades.

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.

The “mandate model” for reform rests on impeccable political logic: 
avoid challenging insurance firms’ stranglehold on health care. But it 
is economic nonsense. The reliance on private insurers makes universal 
coverage unaffordable.

With the exception of Dennis Kucinich, the Democratic presidential 
hopefuls sidestep an inconvenient truth: only a single-payer system of 
national health care can save what we estimate is the $350 billion 
wasted annually on medical bureaucracy and redirect those funds to 
expanded coverage. Mrs. Clinton, Mr. Edwards and Mr. Obama tout cost 
savings through computerization and improved care management, but 
Congressional Budget Office studies have found no evidence for these claims.

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. How sad that the leading Democrats are 
still kicking around Nixon’s discredited ideas for health reform.

David U. Himmelstein and Steffie Woolhandler are professors of medicine 
at Harvard and the co-founders of Physicians for a National Health Program.

________________________________________________
YOU MUST clip all extraneous text before replying to a message.
Send list submissions to: Marxism@xxxxxxxxxxxxxxxxxxx
Set your options at: http://lists.econ.utah.edu/mailman/listinfo/marxism