May 01, 2003 -- Health Care Limps Up Political Ladder

The problem with this sort of article is that is basic assumption is there a
single healthcare crisis, "THE health care crisis" as he calls it. The truth is
there are two health crises, one hitting the working class and one hitting the
corporate class.

Ours is 75 million uninsured, a tattered safety-net, insurance that denies
benefits and drugs, high co-pays, dangerous mistakes in hospitals, and the worst
health indicators in the industrialized word.

Theirs is lost HMO and insurance profits, rising and uncontrollable health
costs, an aging population with expensive diseases, a recession, huge federal
and state budget deficits, and years of expensive war ahead.

The solutions to our problems are directly opposite to the solutions to their
problems. This same conflict will play out, whether in the arena of private
insurance (where health care is a commodity) or government insurance (where
health care is a business operating expense.)

My friend is going downhill on Medi-Cal because she needs mental healthcare in
Marin and autoimmine-fibromyalgea-pain healthcare in San Francisco, but can't
get it, and I'd prefer the governmental way. But the conflict between our class
and theirs will continue whatever plan is adapted.



May 1, 2003

Health Care Limps Up Political Ladder

By ROBIN TONER

WASHINGTON, April 30 - The health care crisis is returning to American politics
- gradually, but inexorably, with a force that will most likely grow as rising
costs and deepening cuts squeeze more and more voters.

Representative Richard A. Gephardt of Missouri, a candidate for the Democratic
presidential nomination, outlined his plan to cover the 41 million uninsured
Americans last week. Senator John Kerry of Massachusetts, another candidate,
will announce his health care proposal in three to four weeks, and former Gov.
Howard Dean of Vermont has made the issue the centerpiece of his presidential
campaign, declaring in New York today that "all Americans deserve access to
health care."

Pollsters say the issue ranks high with Democratic primary voters, which means
that every presidential candidate must address it. It also means that the
ultimate Democratic nominee will be eager to "encourage a broader debate over
health care" with President Bush, Bill McInturff, a Republican pollster, said.

When people are asked to rate their personal concerns, more than a third now say
they are worried about the rising cost of their health care - many more than say
they are worried about losing their jobs, losing money in the stock market or
becoming the victim of a terrorist attack, according to a poll released this
week by the Kaiser Family Foundation, a health research group.

"Health care costs are, and have been for some time, the No. 1 pocketbook issue
in the country," said Geoffrey Garin, a Democratic pollster who is expected to
advise Senator Bob Graham, the Florida Democrat who is another contender for the
presidential nomination.

In contrast to 1991-1992, Mr. Garin said, when the health care issue was fueled
by people's fears of losing jobs and health insurance, the issue today is
"driven by the experience people have of paying a lot more and getting a lot
less coverage for it."

The classic symbols of these rising costs are prescription drugs, particularly
for the elderly; Medicare, the health insurance program for older and disabled
Americans, does not cover outpatient prescription drugs. Congress, in a few
months, is expected to make another effort to create a new drug benefit in
Medicare, but the budget pressures and political divisions will be hard to
overcome.

Meanwhile, rising health costs, coupled with declining revenues, are forcing
states to consider major cutbacks in Medicaid - the program that already covers
millions of people who would otherwise be uninsured. State officials have not,
so far, received the help they are pleading for from Washington. The Bush
administration opposes short-term assistance, holding out for a more
comprehensive overhaul, which critics assert is an effort to limit federal
responsibility for the program.

There is an incongruity here, as Bob Blendon, a Harvard University expert on
public opinion and health, put it: Candidates are proposing bold visions to
expand coverage in the future, "and we don't have enough money to pay for the
present."

Some states are considering cuts deep enough to extend to children, the one
group that politicians of all stripes agreed ought to be covered in the 1990's.
"The idea of reversing that progress is astonishing," said Dr. Irwin Redlener,
president of the Children's Health Fund, a program based in New York intended to
provide coverage to children.

Medicaid has its own special political problems. As Diane Rowland, executive
director of the Kaiser Commission on Medicaid and the Uninsured, said, "it's
thought of as a poor people's program." But, Ms. Rowland noted, Medicaid covers
millions of low-income people in working families, and is increasingly used to
fill in the gaps in Medicare - most notably, for prescription drugs and long-
term care, often for elderly Americans who are solidly middle class until they
live long enough, and get sick enough, to encounter major drug and nursing home
bills.

The Medicaid cuts now being debated in state legislatures have yet to reach a
critical mass in national politics. But some advocates and experts say to give
them time.

"It will impact providers, it will impact the uninsured, it will impact people
on the street," said Robert Restuccia, executive director of Health Care for
All, a consumer advocacy group in Massachusetts. "Harris Wofford will come
again."

Maybe. Right now, there are several contenders for the visionary role filled by
Mr. Wofford, the Pennsylvania Democrat who won a Senate race in an upset and
pushed health care to the forefront of American politics in 1991. Building the
support to pay for that vision is another matter, as the defenders of Medicaid
will attest.