Marie Cocco: America’s Other Civil War

By Marie Cocco

WASHINGTON—If—and the word should be capitalized, italicized, printed in boldface and underlined—the political civil war raging over the Bush administration’s war on terror ever ends, then we will, at some point, have to return to the civil war over healthcare.

Except it seems that the American people have put down their arms.

More than a dozen years after Hillary Rodham Clinton’s grand experiment in reshaping the health insurance system died in a pyre of overheated political argument and hysterical claims, it turns out the public wants pretty much what Clinton tried to deliver: coverage for all Americans. A nationally mandated, guaranteed set of core benefits to replace the current patchwork that leaves even many people who have insurance with inadequate coverage for some illnesses and treatments. A national policy that refuses to let a family be crushed financially if someone becomes very ill.

All this would, naturally, be financed in a way the body politic considers “fair’’—without creating an undue burden on sick people and in a way that’s related to a family’s ability to pay. The most popular means of raising additional funds is through “some form of progressive, or ‘sliding scale’ income or payroll tax (like the Medicare payroll tax) specifically dedicated to supporting health care for all.’’

No, this isn’t a script for a Democratic candidate’s campaign commercial. And they’re not talking points for an interest group pushing this healthcare solution or that.

These are the conclusions of an official, nonpartisan government commission set up by Congress as part of the Medicare prescription drug legislation. What the commission now tells us—after taking soundings in 37 states, collecting tens of thousands of responses to polls and written questionnaires and listening at 98 community meetings—is that Americans see clearly what is wrong with the healthcare system, and have on their own achieved a remarkable degree of consensus on how to fix it.

More than 90% of those who participated in community meetings or responded to the commission’s questions and polls said they believed every American should have affordable coverage. A clear majority wants a mandated, basic benefit for everyone and is “not comfortable with bare-bones benefit packages.’’ There’s agreement, as well, that if doing things more efficiently and reshuffling current government subsidies don’t generate enough money for expanding coverage then—ahem—people are willing to pay higher taxes.

“We found, across the board, that majorities of the population were willing to pay more to ensure that all Americans are covered,’’ the commission said in its report.

All of this is wildly out of sync with the non-solutions the prevailing political system has been trying to shove down the public’s throat. Congressional leaders have, for the past few years, harrumphed mostly about healthcare costs, not about the growing number of Americans without access to insurance. Secure in its willful blindness, Congress has pushed as a panacea “health savings accounts,’’ tax-advantaged plans that do little to expand coverage but do a lot to shift more and more risk and responsibility for health coverage to individuals, rather than employers or the government.

But it’s just this shift—already forced upon most of us by the erosion of the employer-based health insurance system—that’s got people so spooked they’re looking for a collective solution. They’re tired of going it alone as premium hikes eat at their incomes, and as overburdened employers scale back coverage or drop it altogether. The commission found that Americans are changing other aspects of their lives just to cope with the healthcare crisis—older workers postpone retirement, mothers of young children keep working to hang on to their insurance, those with an entrepreneurial urge forgo starting their own businesses.

“All these things really shake people up,’’ says Richard Frank, a Harvard Medical School economist and co-chairman of the panel, the Citizens’ Health Care Working Group. “It’s the general feeling of insecurity—that they won’t get what they need when they need it.’’

This same public anxiety drew presidential candidate Bill Clinton into the healthcare fray in 1992. But somewhere along the way, the political opposition made the fear of change trump the fear of going without care. If somehow, someday, this commission manages to renew the moribund national debate over healthcare, courage is the most potent medicine we’ll need.
   
Marie Cocco’s e-mail address is mariecocco(at symbol)washpost.com.