Why Health Reform May Happen

Let the name-calling begin. A national health plan is again proposed, and its foes are trying to deal it death by unflattering labels. The old favorites include "socialized medicine" and "government takeover of health care."

Some 61 percent of Americans think it's more important than ever to fix the health-care system -- an encouraging number for Tom Daschle, who was put in charge of making universal coverage happen. But the former South Dakota senator knows full well how organized attacks can puncture big majorities.

Harry Truman proposed national health insurance in 1945, and 75 percent of Americans applauded. Then the U.S. Chamber of Commerce issued a pamphlet, titled "You and Socialized Medicine." Doctors joined the assault, and by 1949, support for the plan had cratered to 21 percent.

Richard Nixon tried to launch national health insurance. Bill and Hillary Clinton famously tried. Daschle relates this sad history and shares his own proposal in a book, "Critical: What We Can Do About the Health-Care Crisis."

This is not 1993, when Clinton's vision crashed like a boulder in a fish tank. There were 38 million uninsured then. Today there are 47 million, and that doesn't count another 25 million with crummy coverage. Many millions more fear layoffs that could cost them their coverage.

However ... It is still remarkably simple to frame health-care reform in a way that turns people off.

For example: Some 71 percent of Americans want to require employers to either offer health insurance or pay money into a government pool, according to a poll by the Kaiser Family Foundation and the Harvard School of Public Health. But when asked whether they'd still support that mandate if they heard that some companies might lay off people as a result, the number sinks to 29 percent.

Another question in the survey: "Would you be willing to pay more -- either in higher health insurance premiums or higher taxes -- in order to increase the number of Americans who have health insurance?" Respondents were about evenly split, with 49 percent saying "no" and 47 percent saying "yes."

Enemies of national health insurance will no doubt exploit the weak spots in support. And the group most open to their claims is those who have coverage at work and like their deal.

Backers of a national plan will argue that broad reform would include containing costs while preserving quality. Americans spend $8,000 a year on health care for every man, woman and child -- even counting the 47 million who have no insurance at all. Other rich countries spend half as much, and they cover everyone.

The happily insured must understand that the premiums employers pay ultimately come out of their paychecks. While a national health plan would cost more money in the beginning, it is expected to start saving money in later years.

To win over the happily insured, Daschle would simply build on the current system. The uninsured would pick from a buffet of health plans. The choices would include several private options and one public plan. Expect demagoguing over the latter. The insurance companies don't want that competition.

It was a matter of time before would-be wreckers of a national health plan resumed dark talk about a plot to install "top-down command and control of American medicine" and "HillaryCare." But a lot of things have changed in the 15 years since Clinton failed to make universal coverage an American reality.

Insecurity over health coverage is surging. Spiraling medical costs have made American companies less competitive. And Americans are feeling beaten up by the crashing economy.

This time, a national health plan may survive the bad rap.

COPYRIGHT 2008 THE PROVIDENCE JOURNAL CO.

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Views expressed in this column are those of the author, not those of Rasmussen Reports.

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