Op/ed from The New York Times (edit):
In 1971, President Nixon sought to forestall single-payer national health insurance by proposing an alternative. He wanted to combine a mandate with a program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income.
Nixon’s plan, though never passed, refuses to stay dead. Now Hillary Clinton and Barack Obama propose Nixon-like reforms. Their plans resemble measures that were passed and then failed in several states over the past two decades.
In 1988, Massachusetts became the first state to pass a version of Nixon’s employer mandate — and it added an individual mandate for students and the self-employed, much as Mrs. Clinton (but not Mr. Obama) would do today. Michael Dukakis announced that “Massachusetts will be the first state in the country to enact universal health insurance.” In 1988, 494,000 people were uninsured in Massachusetts. The number had increased to 657,000 by 2006.
Oregon, in 1989, combined an employer mandate with an expansion of Medicaid and the rationing of expensive care. Gov. Barbara Roberts said, “Today our dreams of providing effective and affordable health care to all Oregonians have come true.” The number of uninsured Oregonians did not budge.
In 1992 and ’93, similar bills passed in Minnesota, Tennessee and Vermont. Minnesota’s plan called for universal coverage by July 1, 1997. Instead, by then the number of uninsured people in the state had increased by 88,000.
Tennessee’s governor, Ned McWherter, declared that “Tennessee will cover at least 95 percent of its citizens.” Yet the number of uninsured Tennesseans dipped for only two years before rising higher than ever.
Vermont’s plan called for universal health care by 1995. But the number of uninsured people in the state has grown modestly since then.
The State of Washington’s 1993 law included the major planks of recent Nixon-like plans: an employer mandate, an individual mandate for the self-employed and expanded public coverage for the poor. Over the next six years, the number of uninsured people in the state rose about 35 percent, from 661,000 to 898,000.As governor, Mitt Romney tweaked the Nixon formula in 2006 when he helped devise a second round of Massachusetts health care reform: employers in the state that do not offer health coverage face only paltry fines, but fines on uninsured individuals will escalate to about $2,000 in 2008. On signing the bill, Mr. Romney declared, “Every uninsured citizen in Massachusetts will soon have affordable health insurance.” Yet even under threat of fines, only 7 percent of the 244,000 uninsured people in the state who are required to buy unsubsidized coverage had signed up by Dec. 1. Few can afford the sky-high premiums.
The “mandate model” for reform rests on impeccable political logic: avoid challenging insurance firms’ stranglehold on health care. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.
The debate should be over. How sad that the leading Democrats are still kicking around Nixon’s discredited ideas for health reform.By DAVID U. HIMMELSTEIN and STEFFIE WOOLHANDLER
Cambridge, Mass.
http://www.nytimes.com/2007/12/15/opinion/15woolhandler.html
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