In 1974, former President Richard Nixon and Democrat Wilbur Mills, the powerful chairman of the House Ways and Means Committee, proposed a universal healthcare coverage plan. The bill-called the Comprehensive Health Insurance Plan, or CHIP-drowned in the Watergate and the Washington Tidal Basin scandals later that year. But it had the right stuff to attain the goal of healthcare coverage for all Americans. President Clinton and congressional leaders should think about using the bill as a model.
An updated version of CHIP deserves serious consideration because of these advantages:
*CHIP would have provided healthcare insurance coverage for every American but required minimal new spending by the government and no new taxes. Employers were required to pay at least 50% of the costs of insuring their employees, with the remainder to be paid by workers. Small businesses that might have had trouble covering those costs would have received government subsidies taken from budget surpluses. An employer-based system still makes sense because most of today's 44 million uninsured are working people and their families.
*The sister to CHIP, called the Comprehensive Health Assistance Program, would have replaced nearly all of Medicaid. States would have received federal contributions and contracted with healthcare organizations to cover all state residents who were not covered by the employer-mandated program.
*CHIP was a simple, straightforward financing program, unlike President Clinton's American Health Security Act of 1993, which would have changed healthcare delivery and encouraged government intrusion. CHIP established federal standards but permitted no federal interference in the practice of medicine. And CHIP was laid out in a dozen pages vs. the Clinton plan's 1,400 pages.
The Nixon-Mills plan was basically a fee-for-service system that would have given full freedom of choice to all Americans. Of course, back then, universal coverage would have cost only $39 billion, and today that cost would be much higher. But employers need to understand that providing healthcare coverage is part of the cost of doing business. Just as they pay for workers' compensation and unemployment coverage, they must provide healthcare benefits to attract good employees. Besides, if every employer paid for a health benefits plan, risks would be spread across the working population, and small employers could form purchasing alliances to curb the sharp premium increases they now face.
In addition to cost, another big difference between 1974 and now is that Nixon and Mills controlled the health policies developed by their parties. With their collaboration, the issue was not subject to partisan politics. That kind of collaboration does not exist now, but if we have the right kind of leadership going into the elections of 2000, the bipartisan model could finally succeed.
We've come close to universal coverage several times. In 1912, former President Theodore Roosevelt proposed national health insurance as part of his Bull Moose campaign, but the electorate said no. In 1935, the Committee on Economic Security recommended including national health insurance in the original Social Security Act. But President Franklin D. Roosevelt said no, fearing inclusion would threaten congressional support of Social Security. In 1948, after virtually every other industrialized country in the world had enacted universal healthcare, Harry Truman became the first U.S. president to formally propose a plan. And Congress said no.
CHIP was a victim of its creators' problems. Nixon won a second term with an overwhelming electoral mandate, but Watergate was his undoing. Mills had established himself in the House when a photographer snapped him cavorting in the Tidal Basin with exotic dancer Fannie Foxe.
But a good idea should not have died with them.