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Reopening the health care debate

09/02/02 12:00AM By Madeleine M. Kunin
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(Kunin) It's time to reopen the health care debate. Too many people are going without insurance, and those who have it are riding a wave of rising costs. It's downright embarrassing to know that the United States, one of the richest countries in the world, is the only industrialized nation that does not have universal access to health care. We enjoy this low status while we are spending more than any other country - and getting less.

According to the year 2000 World Health Organization report, France ranks first in having the best health care system. The U.S. ranks 37th; we rank 25th for life expectancy for men and 19th for women. Health care costs rose 6.9% this year.

What can we do? The Clinton administration spent much of its political capital on a new health care system, and it bombed. We tried managed care, and it didn't work. The Congress tried to pass a prescription drug bill for the elderly, and it failed. Where do we go from here?

There are two schools of thought. One is to make incremental changes through Medicare and Medicaid. That was what Vermont did in 1998 to create Dr. Dinosaur. That program is great for children, but what about those adults who are uninsured or paying premiums they cannot afford?

The alternative approach is to make fundamental changes in how we pay for health care. There is a fledgling Vermont organization called Health Care for All, composed of health care providers, consumers and employers. Their proposal is to use the 24% of the health care dollar that is presently used for administration, and apply it to health care benefits. Sounds simple, but there is one major hurdle. Health insurance companies would be out of business. Government, which now pays approximately 64% of health care costs, would be the single health care spigot.

Yes, the proposal will have tough opposition. We learned from Hillary Clinton's efforts that a revamping of health care is difficult if not impossible to achieve without a role for insurance companies. But Health Care for All is a good starting point for a new debate about universal access to health care. Its goals are right, and the pressures for fundamental change are mounting. Employers and employees want change.

The cost spiral keeps going upward, with no easy answer in sight. Health Care for all has an ambitious agenda, but that may be precisely what we need to debate if we are to create a health care system that enables every Vermonter and every American to have access to health care. Americans, who are proud of being number one, should not settle for less in health care.

This is Madeleine May Kunin.

Madeleine Kunin is a former governor of Vermont.
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