Health Insurance for All

Concerned by both the skyrocketing costs of health care and the limitations of private insurance plans, more and more Americans have been insisting that national health insurance is an idea whose tune has come. Despite the rising clamor, there has been little progress toward better health protection. Bills to set up programs ranging from a British-style socialized medical system to more modest plans that would ease the financial burdens of serious illness have languished in Congress for the past four years.

But the prospects for at least limited action by the current Congress are brighter. The Nixon Administration last week submitted a plan that could ultimately offer all Americans some form of coverage. Moreover, there is every indication that the Administration will push hard for its program, thus augmenting the pressures already present in Congress to create some sort of health-insurance system this year. "There has long been a need to assure that no American is denied high-quality health care because he can't afford it," President Nixon told a meeting of the American Hospital Association. "As costs go up, that need grows more pressing."

Cost Ceiling. In many ways, the Administration's program is similar to an abortive plan first proposed by the White House in 1971. Like the earlier bill, the new measure would require all employers to provide their employees with an insurance plan that would include hospitalization, major medical protection and coverage for "catastrophic" or long-term disabling illnesses. The bill would also require employers to pay 75% of the costs of this program; employees would pay the remaining 25% and would be able to deduct part of their payments on their federal income tax returns.

The Administration has also suggested improvements over its previous proposal. The 1971 bill would have left some 40 million Americans unprotected; the new program would set up a Government plan to cover the poor, the unemployed and the self-employed. Nixon's plan would incorporate such existing Medicaid benefits as eyeglasses and dental care for children, provide for mental illness, including alcoholism and drug abuse, and cope with the costs of catastrophic illness by ensuring that no family would have to pay out more than $1,500 for major medical care in any given year. It also includes provisions to control hospital and doctors' fees.

The Administration plan, which would cost between $36 billion and $38 billion and require $5.9 billion in new revenues, has already run into opposition from critics. Some charge that it would provide a windfall for private in surance companies, which under the program would provide the bulk of necessary coverage. Others favor the European-type, Government-financed health plan that would be created under the plan sponsored by Senator Edward Kennedy and Representative Martha Griffiths of Michigan. This plan would have the Government pay all health-care costs from the first doctor's visit.

Senator Russell Long, chairman of the Senate Finance Committee who has been pushing a more modest plan for coverage of catastrophic illness since 1970, has now been joined by Senator Abraham Ribicoff. The two have proposed an $8.9 billion, three-part package that would expand Medicaid eligibility to cover low-income families, have the Government pay all hospital costs after 60 days and all medical bills exceeding $2,000 per year.

While many Senators and Congressmen feel a need for comprehensive insurance, there is a lack of consensus about its structure and financing. There seems little likelihood that the total Administration plan will be adopted in the immediate future. But the Administration's new interest in health has increased the possibility of congressional action this year on coverage for at least catastrophic illness. Some Congressmen, in fact, are so certain that a bill will come to the floor that they are already preparing amendments to expand it.

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