Bill Bradley: Fake Left, Run Right

By Ramon Castellblanch

This op-ed originally appeared in The Hartford Courant, October 15, 1999

To win liberal votes, Bill Bradley has said that "we should move from universal care to universal coverage." Yet Bradley's health plan, when released Sept. 29, was cheered by some of the same folks who booed Clinton's universal health insurance proposal - the Health Insurance Association of America (HIAA) and the Heritage Foundation, for example.

What is happening? Are the HIAA and the Heritage Foundation becoming liberal, or is Bill Bradley moving right? A closer look at Bradley's plan provides the answer.

There are three parts to Bradley's plan: its provisions for Medicaid, for the uninsured and for Medicare. The Medicaid program pays for nursing homes and for health care for people with certain disabilities and some of the poor. Bradley proposes to eliminate this program.

Instead, Bradley would make government support for nursing home care entirely a state-financed program. If a state didn't pay for it, it would be the tough luck of people in the state needing nursing home care. The main government-backed, long-term care option that families have had for the past 35 years would beheaded for oblivion.

The rest of Medicaid would be taken over by the private insurers of the Federal Employees Health Benefits Program. These insurers could charge administrative fees equal to 15 percent or 20 percent of government health care funds for the millions who are disabled or poor. These insurers have a spotty record of controlling health care costs, so physician and hospital costs would rise under this arrangement. The federal employees and retirees already under FEHBP would be in the same health plan as the people formerly on Medicaid. If health care costs of the former Medicaid people rose, federal employees and retirees could be charged for them.

For the uninsured, Bradley proposes a federal law that would mandate them to buy health insurance for their children. So, if a parent had to choose between making the rent or paying a health insurance company, federal law would require them to pay the health insurance company first. Of course, many parents would choose to pay the rent first, making them law breakers.

Although the Medicare issue has been hotly debated this year, Bradley's plan is largely silent on the issue. Medicare mainly pays for health care for seniors. This year, Republicans (including George W. Bush) supported the idea of having the private health insurance industry run Medicare. Democrats (including Al Gore) supported allocating 15 percent of the projected federal surplus to supporting Medicare.

When Bradley did take a position on the Medicare debate in April, he suggested that he would support making it a means-tested program. The cost of Medicare for middle-income seniors would rise steeply. Now, in the light of media attention, Bradley has stopped making this suggestion. While Bradley offers a few small steps to improve Medicare, like small prescription-drug and home-care programs. But Bradley won't say which way he would go on Medicare in the long-run.

Where would Bradley's plan take America? For people who like to slash social programs, it offers the elimination of the Medicaid nursing-home program from the federal budget. For the private health-insurance industry, Bradley's plan offers administration fees for all of Medicaid. For physicians and hospitals, the Bradley plan offers less effective cost controls. For many people without health insurance, it makes being uninsured their fault.

On health policy, Bradley moved to the right. Bradley's plan would endanger long-term care, make Medicaid into a private insurance bonanza and make the uninsured law-breakers. No wonder that the Heritage Foundation and the HIAA cheer his proposal.

Ramon Castellblanch is director of the health care administration program of the school of business at Quinnipiac College in Hamden, Connecticut