Universal coverage advocates put pressure on states

COLUMBUS, Ohio – A push for universal health coverage is being rekindled in some states by the soaring cost of health care and the lack of political support in Washington for federal changes.

Advocates of a single-payer system – where the government would collect taxes and cover everyone, similar to programs in Canada and across Europe – have introduced bills in at least 18 state legislatures. Some are symbolic gestures, but heated debate is taking place in California and Vermont.

In Ohio, doctors, union officials and religious leaders are gathering signatures to get a single-payer health system placed on a ballot next year.

“The level of misery with private insurers is rising, and that’s why we’re seeing this increased activity,” said Larry Levitt, vice president of the California-based Kaiser Family Foundation, which analyzes health care issues. “But whether one state can succeed, I don’t know.”

Not since Oregon in 2002 has a state voted on a single-payer health system. Voters there soundly rejected it, as did Californians in 1994. Both times, the proposals came under fierce assault from the medical, insurance and pharmaceutical industries.

However, Oregon supporters are aiming for another ballot measure in 2008, and a bill in California would have the government pay for health care in a state where 7 million people are uninsured.

Across the nation, the number of uninsured is 45 million and rising, and 16 million lack enough insurance to cover all their medical bills.

Premiums for employer-sponsored health plans rose an average of 11.2 percent in 2004, the fourth consecutive year of double-digit growth, according to the Kaiser Family Foundation. Companies are raising employee fees for health care, increasing co-payments and decreasing benefits.

Mainstream medical groups, including the American Medical Association, oppose single-payer systems. The AMA fears they would stifle the development of new medical technology and create longer waits for patient care should government budgets become strapped for money.

Advocates dismiss those arguments as scare tactics.

“There’s no other solution out there,” said David Pavlick, a member of the United Auto Workers in Cleveland, which has endorsed the Ohio campaign. “The system we have now is immoral, it’s foundering and it’s on its last legs.”

Claims that the system would cost less have merit, said John Sheils, vice president of the Lewin Group, a Virginia consulting firm that conducted a study last year of how a single-payer system would work in California. The study found that the state would save $343.6 billion in health care costs over 10 years.

But Sheils said a single-payer system isn’t a panacea. States could be hard pressed to keep funding levels adequate during recessions, when tax revenues decline.

“There are positives and negatives with all types of health systems,” Sheils said. “The question that has to be asked is, what are we getting out of our existing multipayer system that is worth all the money we are spending on it?”

In any event, voters are still leery. A Kaiser Foundation poll released earlier this year found that 55 percent of Americans opposed a single-payer health system. Thirty-seven percent favored it.

Knowing that, some states are taking incremental approaches.

Maine started enrolling people this year in a state-private program that offers affordable health coverage to small businesses and families. The goal is to bring coverage to the 130,000 Mainers who lack it by 2009.

“It’s really going to the states to push health care reform along,” said Janne Hellgren, coordinator for a universal health care movement in Massachusetts. “Washington just isn’t willing to change the status quo.”