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Ralph Nader > In the Public Interest > What Kind of National Health Care?

WASHINGTON–Americans are now spending over $100 billion annually for a health care delivery system whose inequities, waste and quality deficiencies are so well documented that almost every conceivable political faction now supports some concept of “national health insurance.”

The issue before Congress for the last four years is what kind of national health insurance? In the flurry of proposed plans and revisions of plans, it is difficult for most people to keep track of the differences and promises contained in the various bills now pending.

One way to strip the confusion away is for citizens to ask their Senators and Representatives if they can answer the following questions about the plan they expect to vote for:

1. Will the national health insurance system provide comprehensive health care, including coverage for hospitalization, outpatient services, and drugs without discrimination against the poor, the elderly, the disabled, and rural residents?

2. Will such a system advance the quality of health care to reduce the number of unnecessary operations, prescriptions, and other forms of health care incompetence or malpractice that even conservative medical journals are documenting openly?

3. Is the insurance plan financed by a regressive payroll tax, for example, which simply makes middle income and poorer people bear unjust burdens or will there be a progressive scale including a tax on unearned income, such as dividends?

4. Will the plan control costs or will it simply have insurance company intermediaries permit, as in Medicare, phy­sicians and hospitals to add to the expected and ruinous health inflation spiral at a 20% a year level? In short, is the plan which your Senators and Representative support one that makes health insurance companies, physicians and the drug industry richer with the small taxpayers’ money or do more of these funds reach the patients’ needs?

5. What will the proposed health insurance plan do to advance preventive health care such as nutrition, immunization, occupational health monitoring and early diagnosis? Preventive health care should be a top priority because it prevents sick­ness and disease, reduces hospital and medical costs, and is truly the ounce of prevention that is worth the pound of cure from a dollar and cents as well as human standpoint. For example, hyper­tension, which is estimated by the government to affect 23 million Americans, could be easily and inexpensively diagnosed and mare readily treated if detected early. Yet only in recent months has the Department of Health, Education, and Welfare shown a determination to launch this mass screening program against this massive disease.

Presently, four health insurance bills are competing in Congress–the Nixon plan, the Mills-Kennedy plan, the Griffiths‑ Corman plan, and the Long-Ribicoff plan. The bill which comes closest to meeting the above-noted objectives is the Griffiths‑Corman bill which Senator Ted Kennedy once espoused before hecompromised further by joining Rep. Mills in another version.

None of the bills adequately focuses on preventive health care or prefers group health practice which is especially popular on the west coast. The shifts of position among some Congressional leaders of health care legislation, together with the proliferation of plans which obscures and confuses, have deprived this long-overdue quest by a focused consumer-patient constituency. Yet without this constituency climbing all over Congress for a genuine health insurance plan that provides consumers with a meaningful role and voice, the Congress will bring forth a patchwork on an already iniquitous and failing foundation.

There is no chance of Congress passing a meaningful bill this year but there is a possibility, if not opposed by consumers, of a patchwork, wasteful and inadequate bill becoming law. Far better for a new effort to build up for next year when the Congress is expected to be more sensitive to ordinary folks than to extraordinarily wealthy interest groups who want another massive handout from Uncle Sam under the name of health insurance.