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.
