Debate Over National Health Insurance

Americans pay more for medical care than any other people--$60.3 billion in 1969, nearly 500% more than they spent in 1950. Yet the dividends from this investment are depressingly meager. The U.S. trails twelve other countries in infant mortality rates; women live longer in ten countries and men in 17. One of every 50 Americans has no access to a doctor under any circumstances.

Even so, U.S. doctors' fees are rising twice as fast as consumer prices; hospital costs are soaring five times faster. Neither public nor nonprofit private insurance is adequate to meet present or projected health requirements. In 1968, despite Medicaid, 20% of all Americans under 65 had no hospital, 22% no surgical and 97% no dental insurance.

From Britain to Japan, virtually every industrial country has met its citizens' health needs with some kind of national insurance plan. Not the U.S. Since 1912, at least a dozen such programs have been discussed and discarded in the face of overwhelming opposition. Now a coalition of Democrats, liberal Republicans and labor leaders has united behind a new plan.

Failing Business. At hearings held by the Senate Labor and Public Welfare Committee last month, Committee Chairman Ralph Yarborough described the U.S. health-care system as a "shambles." Edward Kennedy called it "the fastest-growing failing business in the nation." A.F.L.-C.I.O. President George Meany urged recognition of health care as "a basic human right."

All agreed that such a right would be guaranteed by a bill developed by the late Walter Reuther's "Committee of 100" assorted public figures. The bill was introduced by Senator Kennedy last August and is a sweeping reorganization of the country's health system. Essentially an expanded Social Security program, it would create a national health insurance system for all Americans. To meet an estimated price of $57 billion in its first year of operation --less than the nation's current medical bill--the plan would derive 40% of its funds from federal revenues, 35% from an employer's payroll tax and 25% from individual income taxes. The plan would not cut per capita health costs (now $270 a year), but it would greatly increase health coverage. Supporters claim that if the plan had been in operation last year, it would have paid 70% of all personal health expenditures, compared with 30% under existing insurance plans.

The American Medical Association opposes the plan on the familiar grounds that it impersonalizes the relationship between doctor and patient. The A.M.A. suggests instead a system of "Medi-credit" under which the Government would subsidize the purchase of private insurance by low-income families. Nor will the Administration go along with so radical a departure from free-enterprise medicine. It sent HEW Under Secretary John Veneman before the Senate hearings to describe the plan as "alien to our basic traditions," and too expensive as well. According to Veneman, the plan would cost $77 billion a year, much of it at the expense of other programs.

The plan's promoters insist his figures are inflated. They point out that about two-thirds of the cost of their health insurance program is already being spent under the Medicare and Medicaid programs, or laid out by consumers who now pay their own medical bills. Since the new plan envisions far greater efficiency, almost $14 billion would be saved by eliminating administrative waste and overlapping programs. To that end, Max Fine of the Committee of 100 estimated that the Government could shave $1.1 billion from the national health-care bill by abolishing the more than 20,000 different types of policies now offered by 1,800 competing private insurers, the largest of which would become Government contractors. It could save another $6.4 billion by eliminating doctors' overcharges and unnecessary surgery, and by encouraging more cost-cutting group practice.

Seldom Used Rule. In fact, national health insurance has no chance of passage this year. Invoking a seldom used rule, Republicans objected to the committee's decision to hold hearings while the Senate was in session. As a result, the hearings have now been recessed until January, thus precluding any action on health insurance until the new Congress takes over.

But the debate will continue. Having forced the Administration into going on record against national health insurance, Democrats plan to press their advantage in the current congressional campaigns. They will have some powerful allies. Organized labor is firmly committed to the Committee of 100's plan, and will work hard for candidates who support it.

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