America's struggle with healthcare

Forty-seven million Americans are without health insurance, dependent on the emergency room, or getting no care at all. And here we go again with a complicated plan going nowhere.

I say "again" because in 1970 I wrote a book, "Don't Get Sick in America," on the financing of healthcare. I predicted that, because of rising costs, 1970 would be the year for national health insurance – the next big step after Medicare and Medicaid.

It didn't happen then, and not much has happened, legislatively, since. In 1988, Congress passed a bill providing Medicare coverage in cases of catastrophic illness. Because it required senior citizens to pay sizable premiums, the reaction was so stormy that Congress repealed the bill.

Another big push came in the first year of the Clinton administration, when a task force headed by Hillary Clinton produced a complex bill that was shot down partly by the insurance industry using clever TV commercials.

What changed in the interim is that it's not just the uninsured who are hurting. Major American companies say they can't compete internationally because of the high health insurance costs they are stuck with, while governments underwrite the bill in virtually all other industrialized countries.

So, now, another president, another plan. President Bush, beleaguered over Iraq, has produced a healthcare proposal for Congress to chew on. The complicated plan would operate through the income-tax code. Briefly, people who buy their own health insurance would get tax breaks equal to the deductions enjoyed by those who get health benefits from their employers.

How many of the 47 million would be taken off the rolls of the uninsured? The White House says 3 million to 5 million.

But health policy experts say that even that incremental improvement has the potential to destabilize coverage for the 147 million who are covered right now.

A second part of the president's proposal would offer states flexibility in using federal funds to expand health insurance coverage, as Massachusetts is doing and California is considering. However, the funds that would be used for this purpose are the Medicare and Medicaid funds now supporting hospital care for the uninsured.

Now, Democratic leaders indicate that Mr. Bush's bill will be dead on arrival. So, health insurance remains a subject for speeches by Sen. Edward Kennedy (D) of Massachusetts and Senator Clinton (D) of New York – and even Bush.

And America remains where it was in 1970 – the only big industrialized country without universal health insurance.

• Daniel Schorr is a senior news analyst at National Public Radio.