Picture this: 41 million naked people. That's how many people in the United States do not have health insurance, a vulnerability that experts call "going naked."
While the uninsured crisis is not a new problem, it is spurring political action in several states. In the face of widespread un-insurance and soaring annual premium increases for people who are insured, activists in Oregon, California, Maine and Maryland are pursuing what is loosely called universal healthcare, and often more specifically single-payer plans, to get all of their residents covered.
Universal healthcare has two indispensable features: Every state resident must be included for necessary medical care, and the medical care must be paid for using public financing. A single-payer system, as opposed to the multiple-payer situation existing in the United States and elsewhere, is a specific type of universal healthcare: In a single-payer system, the government typically finances healthcare, but private concerns control the delivery of healthcare services.
Oregon is leading the push for single-payer health insurance: Voters in the state, which is known for political independence and is currently host to about 450,000 uninsured people, will register their positions on Tuesday via a ballot initiative called the Oregon Comprehensive Health Care Finance Act.
"Oregon is an incredibly innovative state," Britt McEachern, a spokesman for a 10-year-old group called Health Care for All Oregon said, pointing out that Oregon was the first to pass assisted-suicide and medical-marijuana laws.
"We knew that universal healthcare was not going to come from the U.S. Congress; they couldn't even pass a prescription-drug bill this year. Our group saw long ago that this exact thing was going to happen. Meanwhile, people are dying because they can't get healthcare," he said.
McEachern says the single-payer plan on the ballot in Oregon next week will astound Oregonians by saving billions of dollars. " Everyone will save money, save for state residents in the very highest income bracket, he said.
Insurance companies oppose the initiative, Ballot Measure 23, and unions like the American Federation of Teachers support it. The plan would be funded by using Oregon's Medicare and Medicaid money, a multi-tiered payroll tax of 3 to 11.5 percent and a multi-tiered personal income tax of as much as 8 percent.
Judging by the tepid support for Measure 23 from a chronically ill resident of Eugene who says she goes without the voluntary part of Medicaid insurance so she can afford to eat, the proposal is likely to squeak by if it passes at all.
Rebecca Chait, a 48-year-old resident of Eugene who was diagnosed with post-polio syndrome in the mid-1990s, says she now is forced to choose between eating and paying $50 a month for the part of Medicare that is optional but pays for actual care, as opposed to transportation to a hospital. "That's my grocery bill for the month," she says of the $50.
Chait does not qualify for the roughly eight-year-old Oregon Health Plan intended to ensure health coverage for all of the state's residents because the $1,300 a month she gets from the Social Security Administration is roughly $75 above that program's cutoff line.
Still, Chait who illustrates her frugality by noting that she does not "smoke, drink, party, vacation or leave the house except to go to the grocery and church" is unclear about how to vote on Measure 23 herself.
"I have mixed emotions: I don't want to see people flocking in from Washington or California or Idaho because they see the pickings are easy here," she says. "But by the same token, am I going to die because I can't get proper care when I need it? It's a real Catch-22," she said.
Measure 23 is supported by the 10-year-old, Cleveland-based Universal Health Care Action Network , whose spokeswoman, Rachel DeGolia, sees the Oregon effort as pivotal in the emerging countrywide consciousness about the healthcare predicament.
"The very real sense we have is that the level of activity at the state level is really accelerating. Folks are just fed up with the federal government not doing anything to address the healthcare crisis," DeGolia said. "We have states moving ahead, like in Oregon, about how to handle it themselves."
"The market is not solving the problem, and that means the government has to make sure it happens," she said
Grace-Marie Turner, president of the Galen Institute, disagrees. She calls Oregon's proposal a "terrible, absolutely horrifying idea.
"Every experience we have with public programs like Medicare and Medicaid, and the experience in other countries, proves that when people perceive healthcare as free, they want lots more of it," whether it's acupuncture, surgery, massage therapy or prescription drugs, she says. "Politically, that means the government pays less and less for the care you need, and you wind up with shortages and waiting in lines and a lack of new technology," Turner said.
Her comments were echoed in The Oregonian. The Portland newspaper recently editoralized that the single-payer plan would "turn Oregon into a test case for trying to sail a socialist health dinghy through a perfect storm of market-driven health care," and asserted that it would be "toxic to business."
The market-based solution that Turner supports would depend upon tax credits like those that have been provided for workers displaced by international trade in the Trade Act of 2002, which President Bush signed into law in August.
"We need to provide a way for people who don't get health insurance at work, and who don't qualify for Medicaid or SCHIP (State Children's Health Insurance Program) to use tax credits to help with the cost of buying their own insurance," she said.
Because a majority of Americans acquire health insurance coverage at work the Kaiser Family Foundation Kaiser Family Foundation says 59 percent of those covered get their insurance through an employer the steady stream of layoffs in the last couple of years has made the uninsured crisis widely felt. In 2001 alone, 1.4 million people in the United States lost their medical coverage.
Universal healthcare supporters at the grassroots level are also active in Maryland, Maine and California. And activists in Rhode Island are gearing up for a fight for what some call "healthcare justice."
The Maryland Citizens' Health Initiative is asking state legislators to support three measures in the next legislative session in order to provide healthcare to the state's 600,000 uninsured residents.
The Maine Health Access Foundation, created as the result of Anthem Blue Cross and Blue Shield's purchase of the non-profit Blue Cross and Blue Shield of Maine, is funding a $200,000 study of the costs of a single-payer healthcare system. The study, by Mathematica Policy Research, is scheduled to be released in December, said Amy Thompson, healthcare organizer for the Maine People's Alliance.
Thompson notes that a single-payer bill passed in Maine's House two years ago but was defeated in the Senate by two votes.
Legislation is now being developed in California, where a study of nine options for healthcare reform concluded in the spring that the single-payer system is the best choice., Health Care for All-California is planning a single-payer legislative campaign for 2003 to cover the state's seven million residents who have no health insurance, DeGolia said.