Universal Healthcare? Not from Bradley

By David U. Himmelstein, M.D., and Steffie Woolhandler, M.D.

This editorial appeared in USA Today on Thursday, September 30, 1999

Former Senator Bill Bradley's health plan would deliver billions to insurance companies and HMOs. But it won't deliver the universal healthcare that Americans deserve.

For 15 years, we and 8,000 colleagues in Physicians for a National Health Program have pushed for non-profit national health insurance. The need for change grows each day. The number of uninsured Americans has increased by 6 million since Clinton took office. Millions more have such poor coverage that a serious illness would bankrupt them. HMO patients are hurried out of hospitals and worried that care will be denied when they're sickest and need it most. Seniors can't afford drugs, and hundreds of thousands have been dumped by profit-hungry HMOs. Meanwhile, health costs continue to rise, reaching over a trillion dollars this year; $250 billion goes to health care bureaucracy and profits alone.

Yet Bradley refuses to take on the greedy insurance companies, HMOs, hospitals and doctors responsible for this mess. Instead, he would hand HMOs $193 billion from Medicaid and $65 billion in new tax dollars to cover some of the poor and near poor.

The new tax subsidies would tempt employers to eliminate health benefits for lower in-come employees. And Bradley would ask most uninsured workers to ante up for their own coverage, assuring that tens of millions would remain uninsured. As for children, he would force cash-strapped parents to buy private coverage, offering inadequate subsidies for working families and generous tax breaks for the wealthy.

In contrast, national health insurance would give every American an insurance card good for any doctor or hospital. It would eliminate insurance companies and HMO bureaucracy, saving the 15 cents of every premium dollar they take for profit and overhead. We'd save $150 billion annually on paperwork, according to the Congressional Budget Office - enough to cover all the uninsured, eliminate HMO restrictions, improve coverage for millions, and provide free drug coverage for all seniors. Polls show that most American's favor such reform. But few politicians besides Senator Bulworth, Warren Beatty's fictional anti-hero, have the guts to push for it.

Bradley's plan would just add money without cutting waste. He would duplicate past re-forms that have already failed; e.g., Gov. Dukakis' inept Massachusetts health plan that promised universal coverage in 1988, but saw the number of uninsured in our state double by 1998. Similar reforms in the states of Washington and Minnesota, as well as the Federal Kennedy-Kassebaum and CHIP legislation have failed to cut the number of uninsured.

Bradley promises straight talk, fresh ideas, and the courage to take on vested interests. But his health plan recycles ideas floated by Al Gore, and before him by Richard Nixon and Jimmy Carter. The American people will have to look elsewhere for health care leadership. We need more Bulworth and less bull.

Drs. Himmelstein and Woolhandler are associate professors of medicine at Harvard Medical School and co-founders of Physicians for a National Health Program.