Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, July 27, 1994 TAG: 9407280053
SECTION: EDITORIAL PAGE: A-10 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Medium
Even President Clinton has wavered on his vow to veto legislation that fails to provide some semblance of universality. Administration spokesmen insist he hasn't backed away from his commitment. Let's hope so.
By huge margins in opinion polls, Americans say they don't want to lose insurance if they lose their jobs or their spouses. Nor do they want it to become unaffordable when they need it most, when they have a costly illness.
They will have to pay for such guarantees, a fact the Clinton administration and others have tried to obscure. Even so, universal coverage offers the best means of providing Americans - including middle-class Americans - with both portability when they change jobs, and assurances that they can buy insurance and renew it regardless of "pre-existing conditions."
If lawmakers mandate such changes without requiring everyone to have insurance, many healthy people would opt out, knowing they could not be refused coverage when they got sick. And if only the sick had insurance, rates would rise so drastically that few would be able to afford it. The whole concept of shared risk would vaporize, replaced by shared disaster among those unfortunate enough to develop a catastrophic or chronic illness.
Extending coverage to the millions of Americans who now lack it will be costly. But unless the uninsured are brought under the umbrella, they will continue to do without health care until the need is critical, and the high cost of that critical care will continue to be shifted onto the inflated bills of those who do have insurance - bills paid, for the most part, by employers who provide their workers with insurance.
Supposedly "moderate" measures in Congress promise near-universal coverage without employer mandates by offering government subsidies to individuals who aren't poor enough to qualify for Medicaid, but can't afford to buy insurance. Estimates of the cost of such subsidies run as high as $150 billion a year - and that would likely grow as some businesses started dumping this expensive benefit, knowing their employees could get government-subsidized coverage.
As for Sen. Bob Dole's supposedly "conservative" plan - offering subsidies so the poor could buy coverage and forcing insurance companies to cover pre-existing conditions - not only would it do little to help the middle-class uninsured, it would hurt the middle-class insured. Without universal coverage to spread the costs, insurance companies forced to accept people with pre-existing conditions would have to raise premiums dramatically.
If the logic of meaningful insurance reform points to universal coverage, the logic of funding it requires either a single-payer, Canadian-style system paid for by taxes; mandates on individuals or families; or mandates on businesses. The least onerous of these among tax-hating Americans is employer mandates, accompanied by serious cost-control measures such as tort and insurance reform.
Employer mandates are realistic, extending an existing system that already covers most Americans. They are fair, leveling the expense among all businesses (only some of which now offer insurance). And they can be cost-effective, inducing workers to use health care more responsibly by requiring them to pay a share of the cost.
by CNB