Health-care reform: a continuing tragedy

On Tuesday, Jan. 19, Massachusetts voters went to the polls to hand Republican candidate Scott Brown a triumphant victory over Democrat Martha Coakley for the Senate seat long held by Sen. Ted Kennedy.  

The final score was 52 percent to 47 percent of the votes cast, on a turnout of 65 percent of all registered voters.  Massachusetts Democrats normally outnumber Republicans by more than 2 to 1. On that snowy winter day, Republican and unaffiliated voters turned out in unprecedented numbers; Democrats stayed at home.

Admittedly, Coakley waged a lackluster campaign, while Brown waged a disciplined, energetic and populist one.  The Democrats utterly failed to communicate to their base what was really at stake in this election:  a filibuster-proof Senate. As a result, the health-care reform movement in Washington, D.C., now falls in disarray, at least until the November 2010 elections.

This delay continues a long-standing American tragedy, the inability to adopt the clearly superior reforms of the democracies of Europe, so praised by Republican President Dwight D. Eisenhower. According to the World Health Organization (WHO), the United States stands in no more than 37th place in terms of health outcomes and performance in relation to cost, well behind virtually every country in Europe. One independent research organization after another confirms the WHO result.

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Some legislators urge that Congress still go for the full health-care reform package, but do so under a budgetary “reconciliationâ€� procedure that requires only a 51 percent, not a 61 percent, vote majority, as Dr. Howard Dean has long advocated. A variant on this approach could be to go ahead under standard rules and force the Republicans to filibuster in fact, spending hours reading text from the encyclopedia, and letting Americans witness what the Republicans really do and don’t stand for.  

Others would scale back the health bill to some “core essentials� — provided consensus can be reached on what those essentials are. Or, by “salami slicing� the package, we could present to Congress certain specific reforms individually, notably laws forbidding denial of coverage for “pre-existing conditions� or dropping insurance coverage when an insured person becomes seriously and expensively ill. As reform after reform is adopted, the insurance industry will eventually say wait a minute, and demand “mandated� (required) coverage, to bring millions more into the insurance pool, for their own large-scale profit reasons.

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Finally, there is my own, previously rejected, optimal solution.  What is it?  Here it is:  I believe that the president has the legal and Constitutional right, without going to Congress, to simply request the Department of Health and Human Services, together with Medicare, to establish an initially modest, government-run health insurance plan — a simple health insurance policy like any other, but unlike any other, open to any U.S. citizen as a matter of free choice.

Preferably, this would be modeled on a study undertaken a few years ago by the U.S. National Academy of Sciences, in turn based on the existing WHO health insurance plan, operating in the black in more than 200 countries — including the United States.

Most of the reforms currently being debated in Washington, D.C., would be incorporated in the voluntary public health insurance plan. Based on WHO experience, cost savings would be dramatic. Legislation would not be needed initially, because nothing would be “mandatedâ€� (thrust down the throats of American industry or citizens), and no taxpayer money would be used or budgeted. Eventually, however, as hundreds, thousands and millions of Americans opted for the public, single-payer plan, the health insurance industry would be forced by free market competition to adopt the reforms voluntarily.  

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At a subsequent stage, we would go to the Congress for approval to “mandate� health insurance for all Americans, and to appropriate taxpayer money to subsidize the premiums of those citizens who want insurance coverage but cannot afford it — until such time as they can pay for it. At that point, Republicans will not be in a position to criticize health reform or filibuster an existing public option, but they will have to explain why government should not be involved in helping to bring health insurance to all Americans.

Thus, there’s more than one way to skin a cat. I believe my way is best, of course, but we cannot always have everything our way.  I’ll compromise with whatever actually works. There’s one clear lesson from Massachusetts for the Democrats: If they want to pull the chestnuts out of the fire, they had better get to work, starting right now, to re-capture the populist middle ground, using superior communication, organization and purpose.

Sharon resident Anthony Piel is a former director and legal counsel of the World Health Organization.