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Published on Monday, April 2, 2001 in the Los Angeles Times
If Not Now, When, for Universal Health Care?
by Robert B. Reich
What better time than now to revive the idea of universal health care? There's a huge budget surplus. Meanwhile, the number of Americans lacking health insurance continues to rise (now almost 43 million, up from 38 million 10 years ago). And those who have it are paying more than ever in co-payments, deductibles and premiums. As the economy sinks, working families will have an even harder time. If they lose their jobs, their health insurance may disappear.

Yet nobody in Washington is talking about universal health care. President Bush wants to use the bulk of the surplus for a whopping tax cut, mostly for the rich. If there's any money left, he'd accept a $2,000 tax credit against the cost of family health insurance. But this wouldn't be much help to the typical middle-income family that now pays more than $6,000 a year to guarantee its health care. Even with the tax credit figured in, health insurance would still take a whopping 10% to 15% out of this family's annual income. And the credit would be of almost no use to families that can't afford health insurance to begin with. The Congressional Budget Office recently concluded that a tax credit would have to be more than twice as large as the one Bush is mentioning in order to get most of them insured.

What about the Democrats--the party that first championed universal health care? They don't even want to utter the words "universal health care" because they still believe Bill and Hillary Clinton's ill-fated plan of 1994 was responsible for the Republican takeover of Congress later that year. Democrats don't want to revive memories of that plan for fear of losing electoral support in 2002.

Those fears are misplaced. The Clinton health care plan sank because it was too complicated for the public to understand, which made it a perfect foil for right-wing demagogues. In fact, the public supported the idea of universal health care. Polls taken in late 1993 and early 1994 showed a majority listing "universal health care" as America's most important unmet need. And a public that wanted universal health care seven years ago is almost certain to want it now, as health care bills skyrocket.

Another reason Democrats don't want to talk about universal health care is that they've adopted the old-time Republican religion of fiscal austerity. This gospel won't allow spending of the magnitude required to insure all Americans. Instead, congressional Democrats say the budget surplus should be divided into thirds. One-third would be used to eliminate the federal debt and another third for a tax cut more modest than George W. is proposing. Only the last third would be used for additional spending.

If today's Democrats had their way, they say they'd spend a bit more on Medicaid for the very poor and expanded health insurance for children not quite poor enough to qualify. But this would still leave a huge health gap. The current children's health insurance program reaches only about one-third of the 9 million children already eligible for it--an administrative problem that won't be corrected merely by putting more money into the program. Anything less than universal access leaves out too many families.

It's a matter of simple priorities. There's no more reason to use the surplus to pay down the federal debt than to use it on a big tax cut for the wealthy. Give all Americans affordable health care instead. Yes, it's true that lowering the debt reduces federal borrowing costs, but so what? As John Maynard Keynes pointed out 60 years ago, public indebtedness per se isn't a problem. The underlying question is what the public debt is used for. If the benefits to the public exceed the costs of borrowing from the public, it would be silly not to borrow. And with health care costs soaring and coverage declining, the benefits of universal health care are very high.

Bill Clinton proposed his plan for universal health care when the nation was deeper in debt than it is now and faced annual deficits of almost $300 billion a year for as far as the eye could see. Now we have a budget surplus even Alan Greenspan thinks is too big, and working families need affordable health care more than ever. You don't have to be a rocket scientist--or even a politician--to figure out what has to be done.

Robert B. Reich, Secretary of Labor in the Clinton administration, Is co-founder and the national editor of the American Prospect. His most recent book is "The Future of Success" (Alfred A. Knopf, 2001)

Copyright © 2001 Los Angeles Times


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