The Universal Health Care Debate Rises Again

Remember "Hillary Care"? That was the name critics gave to President Clinton's effort to reform the nation's health care system back in the mid-1990s.

The president picked his wife to head the public commission that was charged with finding a solution to what was then a growing crisis. What followed was one of the most rancorous debates in the nation's history.

That was almost 15 years ago. These days, the nation's health care crisis is still around, bigger than ever, and so is Hillary. The president's wife is now a leading Democratic candidate for the White House, and the health care debate is about to reemerge in full force, both in Congress and in the looming presidential election.

Small businesses, of course, have a huge stake in the outcome. Of the estimated 46.6 million Americans who lack health insurance, most live in families where one or both household heads are employed by a small business.

The inability to offer health insurance — largely because of cost — is one of the biggest stumbling blocks for small business owners to hiring and retaining qualified employees. In contrast, providing employee health insurance can add up to $4 per hour on top of the cost of producing goods or services. In the highly competitive global economy, that puts U.S. businesses at a disadvantage to most foreign companies.

The "Hillary Care" debate was the last time the nation came close to enacting government-mandated national health care. In the end, largely for political reasons, it turned out to be the wrong solution at the wrong time.

The Republican strategy since then has been to push more of the burden for health care onto private individuals and provide tax breaks to help offset the costs. President Bush has made that strategy the centerpiece of his latest plan to solve the crisis.

In his State of the Union address, he proposed a new tax on employer-sponsored health benefits and a tax deduction to anyone who purchases health insurance on their own. The goal is to push consumers into cheaper private health plans, albeit with fewer benefits, and break the nation's traditional reliance on employer-sponsored plans.

As a practical matter, critics say the plan will cause employers, especially small business owners, to drop coverage. And while the administration estimates that as many as 3 million people will gain insurance, most of those are expected to come from the ranks of the middle class. The plan will do nothing to help the working poor, who already pay little or no taxes and won't benefit from tax breaks.

Democratic leaders have already let it be known that the president's plan is unlikely to fly in Congress. So where does that leave the debate? Moving decidedly toward national health care. Sen. Ted Kennedy, D-Mass., who now heads the Senate Committee on Health, Education, Labor, and Pensions, will be a principal architect of any Democratic initiative.

Kennedy charges that the president's plan would only "worsen" the health care crisis. Instead, he is proposing to expand the government's Medicare program to provide truly universal health insurance. Kennedy said he would also consider approaches used in his home state, as well as those proposed by California Gov. Arnold Schwarzenegger, to provide universal coverage.

Republicans on the committee, led by ranking member Mike Enzi, R-Wyo., are focusing their efforts on a measure to create national association health plans. The bill would lower insurance costs for small businesses by allowing them to pool their plans in national groups. Right now only statewide pools are possible.

A powerful coalition of consumer groups, led by 41 state attorneys general, effectively killed the measure last year after claiming it was laden with insurance industry giveaways, particularly a provision that would have banned state health insurance mandates.

Although Senate Finance Committee Chairman Max Baucus, D-Mont., has added small business health insurance to his agenda as well, the issue is expected to get swept up in the broader debate over national health insurance.

Meanwhile, the debate in Congress is likely to become politically charged by the looming presidential election. According to the latest UPI/Zogby poll on health care, 91 percent of those surveyed believe the current system needs to be reformed. Of those, 46 percent believe the overhaul needs to be radical. And an ABC/Washington Post poll found that consumers favored universal government health care by a 2-to-1 margin.

Not surprisingly, every Democratic presidential candidate has their own plan to provide broader, government-funded coverage. Now here's the bottom line: Expect Congress to do little in the way of real reform this year. The Bush administration's plan is dead. Some piecemeal efforts, like the association health bill, may make some headway. But it seems almost certain at this point that everything will be put on hold until the next administration takes office.

Basically, here's how Washington looks at it: After 15 years of stalemate, what's one more year?