The Wrong Prescription
Bill Bradley's Health Plan Is No Cure
By Dr. Ida Hellander and Dr. Steffie Woolhandler
The Progressive magazine, December 1999
The rightward drift of the Democratic Party is nowhere more
evident than in health care. In September, Bill Bradley, the former
Democratic Senator from New Jersey and current Presidential candidate,
declared his support for health reforms, previously espoused by
the ultraconservative Heritage Foundation. Bradley's plan is at
its core profoundly reactionary, a vehicle for the Heritage Foundation's
explicit agenda of "rolling back the welfare state."
Bradley's plan has already been endorsed by Chip Kahn, president
of the powerful lobbying group the Health Insurance Association
of America. And little wonder: Insurance companies and HMOs stand
to gain billions of tax dollars from the Bradley plan, while Americans
would still have no right to health care.
Bradley has impressed many with his ideas on race (and his
jump shot). Yet his health proposal is so shameless in its $200
billion transfer of tax dollars to the private insurance industry
that it might have made Richard Nixon blush. At a time when the
possibilities for progressive reform seem bright, why are Bradley's
health care proposals so backward?
Meanwhile, Al Gore would not guarantee the right to health
care either. Nor would he loosen the choke-hold of the insurance
industry over health policy At most, he trumpets his support for
the Patient Bill of Rights, advocates putting additional money
into the failed Children's Health Insurance Plan, and proposes
a modest tax credit so that some in the fifty-five to sixty-five
age group could buy into Medicare.
While national health insurance was espoused by Warren Beatty's
fictional Senator Bulworth, not a single real-life candidate has
the courage to advocate the nonprofit national health insurance
program America needs and Democrats supported from the New Deal
era until the 1992 Clinton candidacy.
Bradley has compared his proposal for the 11.1 million uninsured
children to the Medicare program for seniors. This is nonsense.
Medicare has guaranteed seniors basic health coverage for more
than thirty years. Bradley's proposal is a mandate that parents
buy their children private insurance. Admonishing parents to buy
private coverage-even if such coverage were affordable and available
(which it's not)-is a long way from guaranteeing kids coverage.
Bradley's plan relies on tax credits and a new federal bureaucracy
to help poor families afford children's coverage. The subsidies
would tempt employers to drop coverage of employees and their
children but wouldn't be adequate to help many low and middle-income
families buy private coverage. This is exactly what happened with
the federal Children's Health Insurance Plan, the most recent
incremental effort to increase coverage. In 1998 alone, the number
of uninsured children rose 330,000, following rises of 188,000
in 1997 and 755,000 in 1996.
Bradley also proposes privatizing Medicaid, the current government
insurance program that covers some of the poor and the disabled,
as well as nursing home costs for poor seniors. The $193 billion
in current Medicaid spending would go to private insurers. The
non-elderly Medicaid recipients would get a voucher to purchase
private coverage from plans participating in the Federal Employees
Health Benefits Program. Bradley would also offer tax credits
to the uninsured to buy into that program.
As for the poor elderly who receive help from Medicaid with
nursing home and long-term care costs, Bradley would simply end
thirty years of joint state and federal responsibility for their
care and turn this over to the states completely (just in time
for the boomers' retirement). Bradley would do the same for the
disabled, risking the loss of the safety net for this vulnerable
With premiums rising at 8 percent per year, poor adults with
Bradley's fixed tax subsidies or skimpy vouchers would be able
to afford only the cheapest plans (mainly HMOs) in the Federal
Employees Health Benefits Program, not the high-end coverage that
members of Congress receive. Many millions of uninsured would
continue to fall through the cracks. As with children, the tax
subsidies for adults are inadequate to cover all the uninsured
but might encourage employers to drop coverage to low-income workers.
For seniors, Bradley would create an optional prescription
drug benefit to cover medication costs over $500 annually. Seniors
would have to sign up and pay an extra premium for this modest
benefit. Bradley's tepid proposal barely scratches the surface
of that problem.
The Heritage Foundation must be flattered by Bradley's adoption
of its ideas. For years, that foundation has pushed a similar
plan for privatizing Medicare in an attempt to reduce public control
while directing tax dollars to private insurers. Heritage scholars
argue that consumers will choose the most efficient private plans
and that competition in the market will reduce costs.
However, the evidence from seniors who have opted for HMOs
is that private plans are actually more costly than traditional
coverage. The U.S. General Accounting Office (GAO) found that
Medicare lost $1.3 billion in 1998 by enrolling seniors in HMOs.
In the past two years alone, Medicare HMOs have dumped 75O,000
seniors who proved unprofitable. HMOs have recruited seniors by
routinely misleading them about benefits. This year, Medicare
HMOs are dramatically scaling back the prescription drug coverage
that lured many seniors into HMOs in the first place. A four-year
study of quality of care by John Ware, published in the October
2,1996, issue of the Journal of the American Medical Association,
found that seniors were more likely to decline in health under
HMO care than in the traditional Medicare program. Yet, instead
of recognizing the failures of Medicare privatization, the Heritage
Foundation and its allies in Congress push on.
While traditional Medicaid is a program of uneven quality,
with large variations by state, the record of for-profit HMOs
in treating Medicaid patients has clearly been worse. Florida
officials banned twenty-one of the state's twenty-nine Medicaid
HMOs from expanding enrollment several years ago after systematic
abuse of patients was uncovered not by state auditors but by courageous
investigative reporters at a local newspaper. These HMOs used
fraudulent marketing tactics (for instance, telling patients they
would lose their Medicaid if they didn't enroll), delivered poor-quality
care, disenrolled sick patients, and spent up to 70 percent of
program costs on overhead and profits.
In Oregon, the percentage of poor women with inadequate prenatal
care and the percentage of low-birth-weight babies rose after
Medicaid recipients were pushed into HMOs. A large experiment
in which families were randomly assigned to HMOs found that low-income
persons fared particularly poorly in the HMO setting.
A national health care system is financially viable. According
to studies by both the GAO and the Congressional Budget Office,
a single-payer national health program would streamline health
care paperwork and, in doing so, save enough money to cover the
44.3 million uninsured. It would allow patients to choose their
own physicians and hospitals, a right citizens of most industrialized
countries take for granted.
Drug companies have the highest rate of profit of any industry,
and the United States has the highest drug prices in the world.
According to a study by Alan Sager and Deborah Socolar at Boston
University, if the U.S. government used its bargaining clout to
negotiate drug prices down to Canadian levels, the savings (about
$16.2 billion) would be sufficient to provide the seventy million
Americans lacking drug coverage with necessary medications.
A recent New York Times article noted that the economy of
Sweden is doing so well that the government is giving seniors
the right to have a personal home care assistant. But when the
U.S. economy does well, as it has since 1992, another seven million
people are thrown into the ranks of the uninsured.
No nation has ever achieved universal health care through
the market. We and the 8,500 doctors at Physicians for a National
Health Program believe that health care should not be a business
but a human service that should be delivered through nonprofit
national health insurance. The United States spends nearly twice
as much on health care as any other industrialized country, including
Sweden, and yet is the only one of these countries that does not
guarantee universal coverage.
An editorial in the Bangor Daily News recently argued that
"health care should be regarded as an essential part of an
enlightened society" and that "health care ought to
be viewed as a right of citizenship and not an obligation of business."
Instead of tinkering with tax credits and HMOs, the candidates
should be debating more fundamental questions.
Bill Bradley and Al Gore are pushing the corporate health
agenda under the cover of liberal rhetoric. That's no way to get