If talk could buy medical coverage, there would be no uninsured people in the U.S.
We Americans have a gift for orating on universal access and accomplishing little. We have been doing it since health insurance expansion was proposed by President Roosevelt -- Theodore, that is -- at the beginning of the 20th century. A succession of presidents, candidates and lawmakers trumpeted the issue but never achieved much. One American observer got it only half right when he said weather was the thing people talked about but never acted on.
Here we are in a new century and a new millennium and still far short of universal access. Lyndon Johnson made a noble stab at it with Medicare and Medicaid, but those actuarially flawed programs leave millions without coverage.
Not only are we not making progress, we're going backward. Despite the roaring expansion of the U.S. economy since 1993, the portion of Americans with health insurance actually fell by 2%.
President Clinton has recycled some of his old proposals in a new healthcare plan aimed at trimming by 5 million the roster of 44 million uninsured (Jan. 24, p. 3). Regardless of the merits of these ideas, the odds are poor that the White House and Congress will agree on anything in an election year.
A little leadership from healthcare providers could only help. A recent poll by the Kaiser Family Foundation and the Harvard School of Public Health found that healthcare was one of the top issues voters will consider in November. But pollsters also found no consensus on how to improve access. Guidance from the provider community could help crystallize an opinion and seize the political moment for at least modest gains.
Groups such as the American Hospital Association, the American Medical Association and the Catholic Health Association have championed the cause. But too often in history, providers have lapsed into health reform Balkanization, fighting over economic turf while the political momentum wanes. One good example was the overhaul plan in Clinton's first term. While providers quibbled among themselves, the insurance industry pounced and killed any chance for reform, be it Clinton's or someone else's.
In this election year, less self-interest and more consensus and unity among providers could keep the access issue alive. People are interested. They might just listen -- and act -- when they enter the voting booth.