Outlook Grim for Universal Health Care

NEW YORK CITY, May 2- The United States is unlikely to offer a national health insurance plan anytime soon even though 75 to 80 percent of Americans support the idea, economist Stuart H. Altman, Ph.D. said during a recent two-day symposium at The New York Academy of Medicine.

Universal access to medical care has been available since 1948 to every person in the United Kingdom, from the wealthy to the destitute, said British and American health care experts speaking at "The Changing Health Care System: A British-American Dialogue." But the United States has not yet followed suit because we're torn as a nation over how to structure and finance the system, according to Altman, the Sol C. Chaikin Professor of National Health Policy at Brandeis University. There is no clear sign that Americans will emerge from that policy gridlock anytime soon.

"It's not going to be easy," Altman told an audience of about 80 people. "I see very strong signs that our problems are going to get worse. We are in the middle of a major increase in the cost of health care."

Providing basic and affordable health care to all residents is a goal shared by the United States and Britain, but making it work has been frustrating to both nations. The United States has repeatedly tried and failed to move beyond a piecemeal health care system. Efforts began in 1912 with Theodore Roosevelt's presidential campaign initiative, and resurfaced most recently with former President Clinton's 1993 attempt.

"In the U.S. for 100 years, we've had intermittent efforts to move towards universal coverage," said Academy President Jeremiah Barondess, M.D. "Despite these and other efforts, we still have nearly 40 million residents who are uninsured."

Britain's system is paid through public taxes and offers coverage for all, yet has been gravely underfunded for decades. While patients are never denied treatment because of a failure to pay, they often wait months to see a doctor in facilities that are sometimes substandard.

"The striking thing for me when traveling around the country is to see how variable (the quality of care) is," said Sir Liam Donaldson, Chief Medical Officer for England's Department of Health, said at the symposium.

The British government decided in April to raise taxes and hike health care spending by an impressive 43 percent in the next five years-the biggest-ever increase. That decision should lead to improvements in the quality of care and has been roundly praised in the United Kingdom. "The British government . . . has recognized the dramatic underfunding of the health care system that's occurred in the past 30 years," said Dame Deirdre Hine, President of the Royal Society of Medicine, which co-sponsored the event.

Americans are deeply divided as to how health coverage should be offered in this country, experts said. Some support a publicly funded plan that would insure the entire nation and would be funded through taxes. Others feel that employers should be mandated to supply health insurance to their workers, and that the elderly, disabled and impoverished should continue to be covered by Medicare and Medicaid. Still others oppose employer-insurance mandates, and would instead use "tax incentives" to expand coverage. President Bush favors this approach, in which uninsured people not eligible for public insurance programs would receive a tax credit to help subsidize the cost of purchasing health insurance coverage. Other Americans oppose any major government initiatives at all.

"The only way we're going to pass this is when there's overwhelming support" for one plan, Altman said. History proves that will require more than just a majority backing. Clinton's initiative was supported by 65 percent of Americans, polls show, yet it died before ever coming up for a vote in Congress.

Incremental improvements to the current system are much more likely to occur than radical changes, speakers said. Expanding the Children's Health Insurance Program that Congress adopted in 1997 would be an achievable first step, Altman said. Linking CHIP to coverage of uninsured parents is another promising option that would cost less than a system-wide overhaul, he said. Karen Davis, President of The Commonwealth Fund, recommended expanding Medicare so that people could buy into the program at age 55, for example, 10 years before they are currently eligible. She also favors creating a "Federal Employees Health Benefits Program" to insure those who lack coverage from employers and are ineligible for the government's Medicare and Medicaid programs.

As it stands, most Americans who have health insurance get it through their employers, or through government-funded programs. But many people who work for a living, still lack insurance. A full 41 percent of Americans earning less than $20,000 per year are uninsured.

"We certainly have a problem with people falling through the cracks," Davis said. "[Expanding the system] is going to require more money. The big question is, where are we going to find the money, given the fact that we've spent a substantial amount of the surplus on a tax cut?"

Posted on May 2, 2002

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