November 30, 2005
Making National Health Care a Priority
By Ed Koch

Healthcare costs in the United States have risen to 15 percent of the gross domestic product and totals $1.65 trillion a year. Those costs have now reached the point where they have become an unbearable burden on the nation. Every level of the public and private sectors is reeling and railing, demanding relief, particularly for the heavy cost of Medicaid, which is a small part of the current expenditures.

Major American corporations, including several airlines, that have sought bankruptcy protection in order to be able to continue to operate have cited healthcare for current workers and retirees as a major and often an uncontrollable cost. An historic mainstay of the U.S. economy, General Motors, will lay off 30,000 workers and renegotiate employment benefits, including health benefits, with the UAW, the national union representing its workforce. GM still remains in perilous financial condition, with its bonds reduced to junk status and the company sometime ago reporting that its per car health costs are equal to the costs of steel used in manufacturing each automobile.

The State of New York is a shocking example of what can happen when medical costs run amok. The New York State Medicaid program costs $44.4 billion a year. That program, which covers over 4 million people, has been the subject of several investigative articles by The New York Times, which concluded that “the program has been misspending billions of dollars annually because of fraud, waste and profiteering.” A huge part of the budget of many counties -- raised overwhelmingly by local real estate taxes -- is allocated to pay the local share of Medicaid, which is only approximately 25 percent of the total cost.

Our nation’s population of 297 million people includes 45 million who are totally without medical insurance. Included in that group are people who have been laid off and not found new jobs whose medical insurance has terminated, as well as people who are currently employed but without employer-provided insurance and unable to afford premiums on their own. We remain the only major Western industrial country without comprehensive national medical coverage for its citizens.

The current reason for our failure to address this issue is the mindset of the Bush administration and the Republican party leadership who simply do not believe that government should provide coverage for every American, preferring that the problem be addressed by individuals and families. However, the status quo results in many of those ineligible for Medicaid or Medicare coverage becoming dependent on the charity of others, unable to secure medical insurance for varied reasons, including inability to pay the premiums.

Regrettably, the Democratic party has failed to make this issue a priority. Its lack of commitment has allowed the Republican Party to prevent even a major discussion of the need for universal medical coverage. One U.S. Senator, Russ Feingold from Wisconsin, has introduced S2576 which by its terms, if enacted, “would force Congress to debate health care reform within the first months of the 109th Congress.” You can be sure it stands little chance of passage now.

If the Democratic Party were to raise the matter in both Houses every day, thereby focusing national attention on the issue, it could, and I believe, would make a difference. The President -- particularly a wounded one as is currently the case -- and the Republican party which is fearful of the expected effect of the Iraq war on the November 2006 election would feel the need to address a priority domestic issue.

While the country is divided on the Iraq war, it is no longer divided on the need for comprehensive national health coverage. There is now a convergence of opinion by state governments, private employers and America’s citizens. They overwhelmingly see universal medical coverage as a matter of right, and they will no longer be fooled by the phony statements and commercials of the insurance companies, joined by some physicians and medical personnel, that our current system is the best in the world and that to provide national coverage is a socialist plot.

We can devise a relatively uncomplicated and unbureaucratic system that has built-in safeguards against abuse by beneficiaries and one that can be reasonably implemented and understood. Representative systems have been in use in Europe for decades and also exist in Japan, Hong Kong, Canada and elsewhere. We need not reinvent the wheel, but we surely can improve on any of the models in the same way we improved the roller skate, making it into the rollerblade. Yet, we might invent a new model of national medical coverage, taking into consideration how many new inventions and discoveries have become available in this computer age. However, I suspect most Americans would be happy to have the same program and coverage that members of Congress currently have, known as the Federal Employee Health Benefits Program, FEHBP, trusting the good judgment of members of Congress when it comes to their own welfare.

Hopefully, the President would take the lead in creating a commission to examine the choices and make recommendations to the President and the Congress with instructions that it report back within six months. If he doesn’t, then a joint congressional resolution of both Houses should provide for such a commission. If that doesn’t occur, then the Democratic minorities in both Houses should in an ad hoc way propose a commission and make the relevant appointments. A commission will make the nation’s citizens aware of the best program available, and those who stand in the way hopefully will feel the wrath of the people at the ballot box.

It is no longer a question of whether we will have a national program of comprehensive health insurance, but only how long before it is achieved. There is no more time to waste.

Ed Koch is the former Mayor of New York City.

http://www.realclearpolitics.com/Commentary/com-11_30_05_EK.html