Analysis: Uninsurance a long-term problem

By ELLEN BECK, United Press International  |  Jan. 23, 2004 at 9:30 AM
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WASHINGTON, Jan. 23 (UPI) -- There are plenty of ideas how to reduce the uninsured population in the United States -- Sen. Edward Kennedy, D-Mass., has added his public-private plan to the mix -- so the big question is whether there is the political will to do anything.

Although that political will is driven partly by a public determination to take action, both are lacking, analysts told United Press International.

The federal government has estimated there are almost 44 million Americans in the United States without health insurance -- an increase of 4 million in two years.

Kennedy's plan, similar to what was proposed last year by his Democratic colleague, Sen. John Breaux of Louisiana, is called the Health Security and Affordability Act. It would combine existing private healthcare coverage -- mainly through employer-sponsored plans -- with a beefed-up government safety net for the low income. It would require businesses either to offer insurance or contribute up to 12 percent of payroll so their employees can obtain coverage elsewhere.

"The failure to enact universal health insurance is an ongoing American tragedy," Kennedy said. "Soaring costs are pricing healthcare out of the reach of individuals and employers alike. Every year, more and more firms cut back on coverage or cancel it altogether."

President Bush, in his State of the Union address Tuesday, proposed using refundable tax credits, an expansion of the health savings accounts and Association Health Plans sponsored by industry groups to reduce the ranks of the uninsured.

Those vying for the Democratic presidential nomination have all proposed healthcare reforms, many including tax credits combined with increased spending for a government safety net for the poor. Only one -- Rep. Dennis Kucinich -- has proposed a single-payer, government-run system that calls for expanding Medicare to everyone.

The uninsured may be a hot topic for discussion on Capitol Hill and on the campaign trail, but there is scant evidence lawmakers possess any political conviction to take action in 2004.

"I would be surprised if anything actually passed this year," National Center for Policy Analysis President John C. Goodman told UPI.

Bush's proposals are not new and, aside from HSAs, already have been shot down in Congress at least once.

"I would not be surprised if both of the (Bush) tax relief proposals make it through the House and probably get stalled in the Senate," Goodman said. "You have to look at the amount of acrimony on the Medicare bill ..."

The political fight over the uninsured could be just as protracted and nasty as the multi-year battle to get the Medicare prescription drug benefit. As in Medicare, possible solutions bring out the very elemental differences between Republicans and Democrats -- whether healthcare should be a government entitlement program or a commodity handled by the private sector.

Even though millions of seniors and under-65 adults agreed a Medicare drug benefit was essential, even after calls for it by presidents of both political parties, lawmakers still needed several years of serious negotiations and bickering to agree to a plan. Democrat critics such as Kennedy contend the bill ultimately passed last fall was far less than adequate.

In an election year it may be safer for lawmakers and candidates to talk about solving the problem of the uninsured, but not actually do anything.

There is little enthusiasm on Capitol Hill even for Bush's small, incremental steps that, according to government estimates, would only affect 4 million people, much less for any sweeping reforms proposed by Democrat lawmakers or presidential hopefuls.

It is estimated the United States spends $1,000 per year on healthcare for each uninsured person -- about $44 billion -- yet the problem remains abstract and vague for many Americans -- hence little organized will to act outside the Beltway.

Bob Blendon, of the Harvard School of Public Health, told the Families USA conference his recent voter surveys find 58 percent are worried they may not be able to afford insurance and one-third are concerned about losing current coverage.

Still, the uninsured problem is not a reality for many -- there is no payroll deduction for the uninsured that draws people's attention -- and it is difficult to know by looking at someone whether that person has insurance or, if they do not, whether it makes a difference. One reason is the costs of the uninsured are dissipated by the healthcare system into small increases over many sectors and in rising health insurance premiums that only recently have begun to draw workers' concern.

Looking nationally, Blendon said he has found most people's main concern still is national security -- healthcare is second. Many working voters, in fact, are satisfied with their healthcare coverage right now.

"What is pushing this issue is fear of insured people about the future," Blendon said. "It is less today than is their concern about tomorrow." He also found when people are informed about the various proposals to reduce the uninsured population, "the problem is they say 'do it' to every proposal."

When told a proposal would require them to pay more taxes, however, Blendon said, "You lose a share of them after they just told you they are for doing it."

He said grassroots organizations are lacking because it is difficult to get thousands of the uninsured together to march on Washington or state capitols. Likewise, proposals that are proffered but encounter even local political opposition often die because supporters lack skills and clout to mount a counter-campaign.

At best, 2004 could be the year Americans begin what many experts think is a much-needed national discussion about the rights and responsibilities of each citizen in terms of healthcare insurance and costs. Action, however, still may be years down the road.


Ellen Beck is UPI's Healthcare Correspondent. E-mail

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