And it could sure use a makeover.

Why a Centrist (No Fooling) Wants Universal Insurance
SOMETIMES, in the crush of news, seemingly minor things that later prove significant are overlooked.

That may have been the case last fall when Senator John B. Breaux of Louisiana said he had changed his mind and was now calling for universal health care coverage because the American system of medical care "is collapsing around us."

That mostly unheralded switch in position could have profound consequences, especially for older Americans. That's because Senator Breaux, a three-term centrist Democrat with a very safe seat, often votes with Senate Republicans and has a history of brokering compromises between liberals and conservatives on thorny issues. His significant shift may make him the linchpin in enacting legislation that could change the face of health care in America.

And it could sure use a makeover.

More than 40 million Americans, one in seven, have no health insurance; their ranks increasingly include middle-income families that have no employee health benefits. Those that do have insurance are facing sharply rising co-payments for drugs and medical services. Then there are those workers in their 50's or early 60's who would love to retire a bit early — which could add jobs for younger workers — but are trapped because they can't afford, or can't get, health insurance to cover them until they are 65 and eligible for Medicare.

And growing numbers of doctors are refusing to treat Medicare patients because of physician payment rate cuts: 5.4 percent last year and an additional 4.4 percent scheduled to take effect on March 1. As a result, Medicare patients who can't find doctors are flocking to already overextended hospital emergency rooms — an inefficient and expensive way to receive routine medical care.

In an interview just before Christmas, Senator Breaux not only reiterated his call for universal coverage, but also said he wanted to achieve it by having the government require every citizen to buy private health insurance, much as drivers are required to buy liability insurance. He plans to roll out a formal proposal and its details later this month.

Such a plan — with another government mandate and a potential bonanza of required payments to private insurers — sounds intended to push those on the far right and far left of the political spectrum into apoplexy. But both sides should take a deep breath and hear him out.

"In our current health care system, we have all these boxes," he said. "If you're old, you're in the Medicare box. If you're a veteran, you're in the V.A. box. If you're working, you're in the employer-sponsored box. Each of these boxes has a huge bureaucracy and spends a lot of money.

"We need to get people out of these boxes which don't make a lot of sense. What we ought to say is that if you're an American citizen, you have to buy health insurance, just like drivers have to have liability insurance. But this insurance should come from the private sector and not be a single-payer plan like the earlier Clinton proposal and what some Democrats are talking about now. I would not support a government-run program. We just can't micromanage health care that way."

But Senator Breaux is quick to say that while the program he wants would not be run by the government, it would be regulated. Premiums would be subsidized by the government, depending on an individual's income. Companies, of course, could still pay the premiums for their workers.

Insurance companies might offer several levels of government-approved coverage with various deductibles and co-payments, much like the so-called Medigap policies available to Medicare recipients. Younger, healthier people might elect a basic plan.

"But everybody would have to buy at least the basic plan," Senator Breaux said. "Competition from the various insurance companies would help control costs; the government would help pay for the program and make sure that it works, that those offering insurance aren't scamming the system and that nobody is prevented from buying insurance or forced to pay higher rates because of things like pre-existing conditions."
http://www.nytimes.com/2003/01/05/business/yourmoney/05SENI.html