Health reform: Back from the dead?

A new bill showing signs of life on Capitol Hill would plug a couple of gaping wounds in America's health care system. But, says the author of a new book on Clinton's ill-fated health plan, more and more Americans are getting sick of the nation's spotty medical coverage.

Published May 9, 1996 9:06AM (EDT)

Health reform appears to have made something of a comeback in the form of the Kennedy-Kassebaum bill, authored by Sen. Nancy Kassebaum, R-Kan., and Sen. Edward Kennedy, D-Mass. The bill, passed unanimously in the Senate, guarantees "portability" of health insurance from one job to another and also bans insurance companies from refusing to cover people with "pre-existing conditions." While there are some wrinkles to be ironed out with the House -- primarily, mental health coverage and so-called medical savings accounts -- the bill is widely expected to become law. Does this mean, despite the complete collapse of the Clinton health care plan, that insurance reform is back on track?

Andrew Ross talked to Theda Skocpol, a professor of government and sociology at Harvard University, and author of "Boomerang: Clinton's Health Security Effort and the Turn Against Government in U.S. Politics," (W.W. Norton) to be published this month.
The Clinton administration always said that the only way to reform health care was to do it all at once, not in bits and pieces, because the "incremental" approach would create more problems than it would solve. Now, here we are with a very "incremental" bill that everybody supports.

Because Clinton's reform plan was such a debacle politically, everyone's rushed into this new received wisdom which says, "Our big mistake was to try to do anything big, and so we're just going to do little things." And this is an election year. Both Republicans and Democrats have reason to do something about health care, because 80 to 90 percent of Americans say they still want reform.

Will the Kennedy-Kassebaum bill work?

Those who are already insured get to stay insured if they lose their job. Of course, they have to be able to afford to pay the premiums. There are also rules about people not being canceled for pre-existing conditions -- but the insurance companies are free to charge anything they want. The bill does not address the growing problem that caused Americans to want fundamental health reform in the first place.

The uninsured.

That number of insured was 38 million when Clinton proposed his Health Security plan. It's now 41 million. It's going up by a rate of a million or more a year. That does not count people whose insurance coverage is eroding in value -- or those employers who are shaving back on what they're offering employees. You get sick, only to discover that your plan doesn't cover it.
Even though it passed 100-0 in the Senate, there have been criticisms of Kennedy-Kassebaum -- that by accepting pre-existing conditions, often considered to be "bad risks," the insurance companies will likely raise the rates for everybody. Is that true?
Oh, yes. They will raise the rates for everybody.

Sen. Dole wants to include medical savings accounts in the final legislation. What is your view of them?

If they stay in as Dole proposed, Clinton will veto the bill. They are tax subsidies for wealthy, healthy people while providing payoffs to insurance companies like Golden Rule that want to break up the big insurance pools. Even the big insurance companies oppose the MSAs because if the wealthiest, healthiest people are taken out of the common pool, insurance will just get more expensive for everyone else.

Mental health coverage has been tacked onto the bill. Is it viable, politically?

It won't survive, even though there are many mental conditions that could and should be covered by a basic plan -- conditions that can become much worse later on and cause high expenses. For example, depression can be treated inexpensively with medication, but if you let it go, it can cause really terrible disasters.

Is this incremental, one-step-at-a-time approach the only future for health reform?

Right now, and for the next few years the battle front is going to be whether Medicare can be preserved as a broad-gauged plan that covers all older Americans. Meanwhile, the problems that led Clinton to propose comprehensive health security are going to proceed apace. There will be more and more uninsured who will get less and less access -- even to the most basic emergency services. I also think the middle class will become more and more disgruntled as they are forced into managed care plans that don't offer them the coverage that they expect.

If you had been Hillary Clinton or Ira Magaziner, or another architect of the Clinton health plan, what would you have done differently?

They should have paid a lot more attention to building a broad political alliance before they launched it. They should have been much more straightforward in explaining how the plan would work. They tried to disguise the plan. The trouble is, they fooled their supporters, but didn't fool their opponents.

At the same time, we're seeing more of managed care, which was one of the main components of the plan, and not everybody is happy with it.

Doctors are very upset with it, and so are increasing numbers of patients. I think we'll see more of what we saw last year, when there was a movement in many states to require insurance companies to allow mothers of newborns to stay in hospital two days instead of one day. I expect there will be more of those kinds of movements as insurance company abuses come to light. But unless we find the will as a society to put more public money into health insurance -- or to tell the insurance companies they can't take 25 to 30 cents on every dollar -- we're not going to be able to cover everyone. I wish that will was easy to find, but it isn't.

Quote of the day

The GOP's new voice of reason

"I have to be careful what I say about them because they get so personal and vicious. But I think when he beats up on women, on gays, on blacks, I think that is something we should not tolerate. I happen to be pro-life, but, by gosh, if we start excluding people who are pro-choice, we're going to be a pretty small party."

-- A kinder, gentler Sen. Alfonse D'Amato, R-N.Y., on Pat Buchanan, his sister Angela Bay Buchanan, and the Republican party.

By Andrew Ross

Andrew Ross is Salon's executive vice president.

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