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Is it finally time for a national health plan?

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Sydney Bild, an 80-year-old retired doctor who's been lobbying for a national health care plan for more than 50 years, was recently invited to a luncheon held in the Loop as part of Cover the Uninsured Week. He says the publicist in charge of the event, which was sponsored by the Robert Wood Johnson Foundation, asked him not even to mention the idea of a national plan. "She told me the event's limited to information about the plight of the uninsured," he says. "Speakers were told not to offer any solutions. It was just to acquaint people with how terrible the situation was--as if people don't know how terrible it is. To me it seemed like an exercise in futility--another study, another report."

Nearly ten years after President Bill Clinton's national health care plan crashed, national columnists have started writing again about the dire need for one, Democratic presidential candidates are proposing broad plans, and foundations and health groups are demanding that attention be paid. And Bild is worried that they're making some of the same mistakes they did last time.

Now president of Metro Seniors in Action, Bild has been calling reporters and writing letters and articles on the issue ever since he retired a few years ago. "We need a single-payer plan--it's that simple," he says. "You can't mess around with this. You can't run away from it because the opposition is strong. The issue's too important. The only way to do this right is to have a national plan where everybody's in and everybody pays. We have to take the profit out of medicine."

Bild has been advocating such a plan since he was a medical student in the late 40s and early 50s. "I remember the Truman plan in 1950," he says. "Of course I supported it. Universal health care--why not? The British were doing it. The Canadians were about to implement their plan. Who would have thought that over 50 years later we still wouldn't have it?"

According to Bild, the fiercest opposition to a national plan in the 50s came from the American Medical Association. "The AMA opposed it because they had a fundamental opposition to health insurance, as hard as that sounds given our current situation," he says. "When I was a kid growing up in the 30s we paid for health care out of pocket. It was 'an apple a day keeps the doctor away.' You didn't visit the doctor unless you had to. There was no thought of preventive medicine. The AMA wasn't even a big fan of private health insurance. They were suspicious of it. Health insurance had been introduced in Germany under Bismarck, and it had become associated with the idea of socialism. The AMA's attitude was they didn't want the government telling them what to do. They hated anything that could come between a patient and doctors."

In 1951 Bild graduated from the University of Illinois' medical school and went to work at Cook County Hospital. In 1956 he opened a neighborhood practice on 55th Street in Hyde Park. By then, he says, the AMA's attitude toward health insurance had softened--so long as it was controlled by for-profit insurance companies and not the government: "We were slowly drifting toward the for-profit health care model we have now."

In 1975 Bild and several other doctors opened the Hyde Park Kenwood Community Health Center. "It was an exhilarating time," he says. "We had a community board of directors, and we were paid by the year and not by the patients. In 11 or 12 years, from roughly '75 to '86, we had a patient population of about 15,000. The people joined on the basis of belonging to a number of health plans, most of which they had through their employer."

In 1986, Bild says, the health center was bought by the Michael Reese Health Plan. Eventually Reese was bought by Humana, then Advocate took over the center. Each company ran the clinic as a health maintenance organization, and so it became an ancillary operation in a larger corporation. Doctor fees and services were ultimately approved by the corporation.

"Everything's changed," says Bild, who still lives in Hyde Park. "I don't think it's possible for a Hyde Park Center to exist anymore. Health care costs are so expensive. It's really impossible to put your arm around those costs except the way the HMOs have. The HMOs were allowed to control costs by controlling doctor fees. HMOs train their doctors and teach them how to practice medicine according to their dictates--don't refer too many patients to emergency rooms, don't refer them to too many specialists. It's not about health care anymore. It's so profit ridden. It's ironic, but in some ways the worst fears the AMA had came to pass, only with a twist. They opposed Truman's plan because they didn't want government interference between the patient and the doctor. Well, now they have giant corporations who hire doctors who have learned to become trained beasts."

By the end of the 1980s the skyrocketing cost of health care had forced many companies to either drop or dilute the insurance plans they offered employees. About 37 million Americans had no insurance, and businesses that still had plans strained to keep up with the cost. "From 1965 to 1989," writes Theda Skocpol, in the 1996 Boomerang: Clinton's Health Security Effort and the Turn Against Government in U.S. Politics, "business spending on health benefits climbed from 2.2 percent to 8.3 percent of wages and salary."

In 1991 health care emerged as a major political issue, when a relatively unknown Democrat named Harris Wofford won election to the U.S. Senate by championing the need for a national health care plan. "I believe there is nothing more fundamental," he said, "than the right to see a doctor when you're sick."

Wofford's strategists, James Carville and Paul Begala, went on to work for Clinton in his first presidential campaign. They urged Clinton to run hard on the health care issue, figuring it would give him an advantage with middle-class voters, who were worried about rising costs and declining care, particularly given the recession the country was in. Clinton was elected in 1992 in part because of his promise to address the country's health care problems.

On September 22, 1993, Clinton made a nationally televised speech on the issue. He held up a plastic "health security" card, claiming it would guarantee bearers the right to treatment at almost any hospital or medical center. "On any given day, over 37 million of our fellow citizens, the vast majority of them children or hardworking adults, have no health insurance at all," he said. "And despite all of this, our medical bills are growing at more than twice the rate of inflation."

Clinton promised a system in which recipients would remain covered even if they lost or switched their jobs, even if they left a job to start a small business or retired early. "If you or someone in your family has a preexisting medical condition, you're covered," he said. "If you get sick or a member of your family gets sick, even if it's a life-threatening illness, you're covered. And if an insurance company tries to drop you for any reason, you'll still be covered--because that will be illegal."

Within a year Clinton's initiative was dead. The closest his administration came to a national plan was Kid Care, a system in which the children of poor people--but not the poor people themselves--were guaranteed free health service.

Why did the president's plan, devised largely by Hillary Rodham Clinton, fail? For starters, it was cumbersome, confusing, and hard to explain, even for its backers. "Clinton tried to please everyone," says Bild, "and he wound up pleasing no one." It wasn't a single-payer scheme, so Clinton's union and left-of-center political base felt betrayed. It wasn't close to the status quo, so insurance companies feared they might lose millions of dollars. And it was easy to ridicule--one Republican senator called it the sort of "incredibly bloated, complex, unresponsive, incomprehensible" plan that had come to "symbolize everything people hated about government." GOP strategist William Kristol wrote a widely circulated memo calling on Republican congressmen to oppose the plan "sight unseen," as a way to attack Clinton. Kristol said that any Republican legislator who attempted to forge a compromise deal should be punished by party leaders, adding, "Stray Republicans who delude themselves by believing that there is still a 'mainstream' middle solution are merely pawns in a Democratic game....Its rejection by Congress and the public would be a monumental setback for the president, and an incontestable piece of evidence that Democratic welfare-state liberalism remains firmly in retreat. Subsequent replacement of the Clinton scheme by a set of ever more ambitious free-market initiatives would make this coming year's health policy debate a watershed in the resurgence of a newly bold and principled Republican politics."

Yet in the ensuing years the Republicans haven't advanced any health initiatives--bold, principled, or otherwise. And now, says Bild, the system's "worse than it was ten years ago--much worse." An estimated 41 million people have no insurance, and another 30 million are underinsured. Health care costs are still rising. This year, says Bild, "We're going to spend, what, about $1.4 trillion for health care alone. The government expects that by 2012 health care will be $3.7 trillion if trends continue. It raises the cost of products because everything that a company produces has to include the cost of health insurance. You can't just ignore the problem. The public has health needs--people who are sick are a danger to the entire community. A healthy population is part of public policy. That's why we have boards of health. Aside from it being inhuman to allow people to suffer because they can't afford necessary care, it's just dangerous."

Bild believes that Democratic politicians, union leaders, health care officials, doctors, and those who work with the poor should rally around a single-payer plan similar to the Canadian plan. "The Canadian system is paid for out of taxes," he says. "They pay far less than we do overall, but they get better service. People armed with a medicare card go to any doctor, and the doctor has to perform any health care for them and cannot charge more than the going rate, which is determined by federal government fees after arbitration and discussion with medical associations so doctors are not being pauperized."

He thinks the supporters of any national plan need to take the offensive. "You might as well steal a page from the right," he says. "They don't compromise on their goals before they submit their plans. They aggressively push for what they want. By doing so they push the center in their direction." And, he says, "If you lose, you lose. At least you fought for what you believed in."

Bild has been disappointed with the reaction to his lobbying, particularly among people he sees as his natural allies. A lot of those people attended the series of local events sponsored by the Robert Wood Johnson Foundation during Cover the Uninsured Week. A press release about the events posted on the foundation's Web site says, "All of us business and labor groups, health care leaders, elected officials, universities, faith communities need to work together to help every member of our community understand the plight of those who go without health coverage of any kind. The week provides opportunities for people from all walks of life and every point of view to come together to increase the visibility of the problem, help their uninsured neighbors and begin a reasoned public discussion of proposed solutions to this problem."

Bild decided not to go to the luncheon. In fact he thought the whole series of events a waste of time. "It's time to stop showing the photographs of the sick and the lame and do something about them," he says. "It reminds me of the Clinton plan. There's no leadership. They're afraid of resistance. The Republicans have made the Democrats so ashamed of the New Deal. Everyone's whispering, 'Oh, let's not upset the other side into opposing us.' They're looking for a consensus position, which will be some sort of layered private-insurance program, in which people receive a tiered policy based on their ability to pay. The more you pay, the more comprehensive the policy. In other words, more of what we already have. Well, I have bad news for you--what we have doesn't work."

Art accompanying story in printed newspaper (not available in this archive): photo/Yvette Marie Dostatni.

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