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An Amnesiac Healthcare Plan

Marie Cocco
Columnist
Marie Cocco is Executive Director Strategic Communications for BlueCross BlueShield Association in Washington DC. Cocco was among the first journalists to report the emergence of a business-backed movement…
Marie Cocco

WASHINGTON — John Edwards is trying to get ahead of the political curve, but he would send us back to the future. To 1993, to be exact.

Edwards would repeat the mistake that was at the heart of Hillary Rodham Clinton’s misadventure in trying to fix a health insurance system that was then, and is now, so out of whack that it manages to cover fewer and fewer Americans at higher and higher cost.

As Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business. He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.

The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.

So Edwards wants them to be able to buy a new public insurance plan that would be like Medicare, but not exactly. And he wants affluent people to pay more taxes to support coverage of the less fortunate, but not directly.

Instead of simply asking for a straightforward tax to pay for covering the uninsured, Edwards falls back on that popular circumlocution, the tax credit. The credits are indirect subsidies that would be given to individuals so they could then purchase insurance. The political virtue of tax credits is that their cost is always half-hidden beneath a pile of budget documents — unlike tax hikes that show up as money withheld from paychecks but that pay directly for a government service. Because of this obfuscation, politicians in both parties love tax credits.

Edwards wants congratulations for being the first serious presidential candidate to offer a comprehensive idea for universal health insurance coverage, something every Democratic aspirant is bound to do eventually. Edwards is a smart man and a cunning politician. But his health insurance plan suffers from an odd combination of ailments.

One is political amnesia. This Clinton-like plan that would have both individuals and employers buy into closely regulated health insurance pools failed more than a decade ago — in part because it was so complicated as to be incomprehensible. Another is timidity. Edwards won’t acknowledge that the current system of private insurance is irreparably broken.

It has failed to expand coverage to millions of workers who are employed by small business, or who work part time, or who toil at low wages — companies with high proportions of low-wage workers are far less likely to offer insurance than those whose employees earn more, according to research by the Kaiser Family Foundation. Since 2000, the portion of businesses that offer any insurance to even part of their workforces has fallen from 69 percent to 61 percent.

Over the past year, a solid majority of those who do have coverage — 60 percent — experienced an increase in the amount they are responsible for paying under their plan, the Employee Benefit Research Institute says. Almost a third of covered workers reported difficulty in paying for basic necessities such as food, heat and housing because of rising healthcare costs.

This isn’t much of a foundation upon which to construct a new system. In the years since Clinton tried to build on this inhospitable terrain, the ground has eroded further. It makes no sense to try to shore it up with an awkward hybrid of public requirements and private insurance that would keep in place unnecessary complexity and bureaucratic expense.

Edwards’ advisers say the candidate didn’t push public, single-payer insurance — like Medicare — because the employer-based system is what we have today and therefore it would provide the quickest way to cover the uninsured.

But we also have Medicare today. The elderly still get care from private doctors and hospitals, and administrative costs are a fraction of what they are in the private insurance industry. And people tend to like it.

It would be just as easy — and certainly simpler — to use Medicare as the foundation for a new insurance system to eventually cover everyone. But that would require candidates to be leaders — and show more courage that those politicians who simply say they have a plan.

Marie Cocco’s e-mail address is mariecocco(at symbol)washpost.com.

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