111111111111
NATIONAL HEALTH LINE TERRY MIZRAHI
TOWARD A NATIONAL HEALTH CARE SYSTEM: PROGRESS AND PROBLEMS National health care reform has come a long way since I wrote about it in this column a year ago (Mizrahi, 1991). Social workers have continued to play a major role in promoting a singlepayer, universal system of comprehensive health and mental health care at the national and state levels. The National Association of Social Workers (NASW) has maintained its leadership on the federal scene. On June 9, Senator Daniel K. Inouye introduced NASW's bill, the National Health Care Act of 1992 (S. 2817), to the Senate. This column will present some of the reasons for the mushrooming political interest in health care reform, analyze some of the legislative approaches to the crisis in health care cost and access, identify some of the major bills being considered by Congress, highlight the NASW health care bill, and discuss some strategies to influence the health care debate. CHAOTIC AND COSTLY HEALTH CARE SCENE
The momentum for legislative change at the national level seems to be growing. Whether this can be hailed as a progressive health reform movement remains to be seen. But this type of activism from disparate and ultimately competing (if not conflicting) interests has been placing health care on the front pages. Perhaps the turning point was the upset victory of Pennsylva-
nia Senator Harris Wofford in November 1991. One of every three votes cast for him was reported to be based on his position that health care is a right (Kemper & Novak, 1992). The depressed economy, with increasing unemployment and lack of growth, bas contributed dramatically to the growing concern about health care. The number of uninsured and underinsured people grew as companies cut back or eliminated their health benefits this past year. A public citizen survey showed that the number of Americans without insurance increased by 1.3 million between 1989 and 1990, with 74 percent of them earning more than $25,000 (Kemper & Novak, 1992). At the same time, the burden on American families to pay the greatest share of the national health care bill increased to $6,535 per family, of which $4,296 is actually paid by the families and the rest by businesses. Families pay 32 percent of the $4,296 directly out of pocket; general taxes pay 40 percent, insurance premiums pay 17 percent, and the rest (12 percent) is paid by Medicare payroll tax and premiums. Aggregate U.S. health spending by families (two-thirds of all health spending in 1991) has increased even faster than the average health spending per family. Average family spending increased 147 percent since 1980; the total payments by families increased 193 percent between 1980 and 1991. Moreover, since 1980, health cost increases far
CCC Code: 0360-7283/92 $3.00 ©1992, National Association of Social Workers, Inc.
167
outpaced increases in family incomes (Families USA Foundation, 1991). Between 35 million and 38 million Americans are uninsured, and another 50 million to 60 million people are underinsured. (The latter group holds bare bones health plans with major restrictions or uncovered services.) Sixty percent of poor people are not covered by Medicaid, and only one million of 30 million senior citizens have coverage for long-term health care. In 1990, about one-quarter of American women received no prenatal care, a figure that has risen 50 percent since 1980, when President Reagan took office (Borderline Medicine, 1991). The lack of coverage for mental health services in this country is abominable by almost any standard. The National Mental Health Association (1991) pointed out that of the 153 million Americans with some private health insurance coverage, access to mental health services is much more restrictive than physical health services. Inpatient and outpatient benefits are far less comprehensive, maximum benefits are lower, deductibles and coinsurance are higher, and the percentage reimbursed is substantially smaller. Yet the United States is number one in health care spending. It is estimated that we will spend $800 billion in 1992. Spending has been projected at more than $1.4 trillion by the year 2000. Government expenditures for health care as a percentage of all federal spending increased from 12 percent ($69 billion) in 1980 to 15 percent ($191.5 billion) of the much larger 1990 budget (Iglehart, 1992). Recognizing that this country ranks 17th in life expectancy and 22nd in preventing infant mortality, one can question whether we are getting our money's worth. GETTING ON THE HEALTH BANDWAGON
From the more than 300 health care bilis that have been introduced as of April 1992 in the 102nd Congress, it appears that almost everyone has climbed on the health bandwagon. Liberal union and consumer groups have been joined by groups as diverse as physicians, the health 168
insurance industry, and the business communis. Reasons compelling such involvement vary. Different definitions of the problem lead to different solutions, yet all the groups seem to altree that the federal government must take the lead in providing the solution or in ensuring that the private sector does. Health proposals are usually grouped into three types, moving from minor to major change. The least change is found in the limited smallgroup market health insurance plans; the middle ground is found in the employer "play or pay" proposals that require employers to either provide basic coverage for their employees or pay the government a tax to insure their employees under a public program. The most comprehensive change—the single-payer system—promotes universal health care under one program (see Gorin & Moniz, 1992, for an analysis of these approaches). Smalt-Group Market Reform
Progressive groups, including NASW, are actively opposing small-group market health insurance reform as represented by bilis submitted by Senator Lloyd Bentsen, Representative Dan Rostenkowski, and Senator John H. Chafee. These proposals attempt to increase access to health care by enabling small businesses (usually fewer than 50 employees) to purchase private insurance. This is a prime example of illusive "reform" in that these proposals do not address rising health care costs. They provide no guarantee that health coverage is affordable or comprehensive, and they do not cover other needed services. There usually are high out-of-pocket costs for consumers, and these proposals eliminate many of the consumer protections that now exist in state law. Mandated benefits (including mental health), requirements for the managed care industry, and regulation of utilization review are eliminated. Finally, the proposals continue to use the private insurance model, with its extremely high administrative costs (33.5 cents to 73 cents versus 2.5 cents per health care dollar for Medicare) (National Association of Social Workers, 1992).
HEALTH AND SOCIAL WORK /VOLUME 17, NUMBER 3 /AUGUST 1992
Pay or Play and Bare Bones Approaches
NASW Health Plan: The Best of the Possible
Pay or play and bare bones proposals cover all businesses, so they are broader in scale than the small group plans. They include the Democratic leadership's bills S. 1227 (Health America: Affordable Health Care for All Americans) and H.R. 3205 (Health Insurance Coverage and Cost Containment Act of 1991). However, these proposals continue the same employer-based system and use of costly private insurance. They do little to contain health care costs. This approach results in a shift of higher-risk employees to public programs, maintaining a two-class system with differential access and quality for those with and without private insurance.
NASW has a detailed cost analysis and has calculated the financing and spending estimates accompanying its health plan. The NASW plan as a single-payer system has some unique features in addition to the components it shares with the other current bills. It provides for a full range of mental health services, includes a proposal for long-term care, and encourages the coordination of care through the development of nonprofit "integrated health service plans." Care coordination is also provided for individuals with multiple, costly health problems and is mandated as part of long-term-care benefits. This plan incorporates a strong emphasis on community-based outpatient programs, health care planning, and consumer involvement at all levels. The cost analysis by NASW includes estimates with and without limited cost-sharing and longterm-care benefits. The current cost of U.S. health care services is estimated to be $738 billion for 1991 and approximately $800 billion for 1992. NASW estimates that its NASW plan, including long-term and dental care, would increase national health expenditures to $742 billion in 1991 dollars. The slightly greater cost reflects a projected increase in use of ambulatory care; dental care; and other professional services, including those of social workers and psychologists. Most important to consider are NASW's projections over the next decade. If the current health care system remains unchanged, it is expected to cost $1.959 trillion, or 15.5 percent of the gross national product in the year 2002. NASW's plan, including long-term care, is projected to cost $1.762 trillion in 2002, almost $200 billion less. Other estimates indicate that a single-payer system can save up to $600 billion a year. Moreover, the annual rate of inflation of health care costs under the current system is 9.5 percent; under NASW's plan it is expected to drop to 7 percent (National Association of Social Workers, 1990). These cost projections contain conservative estimates on savings. They do not include what
Single Payer Approaches -
Comprehensive, universal approaches are supported by social workers and other consumer, labor, and public interest groups. Single-payer proposals are financed primarily .through progressive taxation, administered by states, that would pay all providers, thus eliminating the approximately 1,500 private insurance companies. Bills introduced by Representative Marty Russo and Senator Paul Wellstone most closely approximate the ideal financing model. (It is important to note that none of these health reform mechanisms drastically changes the service delivery system or appreciably alters the power relationships in health care.) The progressive aspect is that these proposals provide comprehensive health and mental health coverage under one program, using the current mix of public and private providers. They eliminate consumer out-of-pocket costs and control costs by curtailing waste, regulating provider fees, and establishing global budgets for hospitals. Consumers are still free to select their providers. For hospitals, they eliminate most administrative overhead and paperwork such as billing, collecting, and the completing of multiple forms of different insurance companies. Also, by guaranteeing payment, they eliminate the need to recover costs for uncompensated care through cost-shifting or deficit spending. NATIONAL HEALTH LINE
169
are expected to be significant long-term savings resulting from expanded health promotion and prevention activities (especially as related to prenatal and child health) and from anticipated lower rates of inflation in health care costs. Fears of increased taxes for consumers appear to be unfounded. By eliminating almost all out-of-pocket health care spending, NASW estimates that 80 percent of families and individual senior citizens (and 60 percent of senior married couples) would spend less than or the same as they now spend on these out-of-pocket costs for uncovered services, premiums, deductibles, and coinsurance. Parallels at the State Level
Movement for health reform at the state level remains strong. The different initiatives mirror the variety of approaches at the federal level. Minnesota passed a bill in April 1992 that, although not a single-payer plan, is considered a first step toward health care reform and universal coverage. Twenty-two states are promoting progressive measure ("States Taking Lead," 1992). However, there is also a move afoot to promote bilis like the one passed in Oregon. Considered a rationing proposal, it raises questions about the trade-offs involved in eliminating certain covered services from Medicaid in exchange for including more people in the Medicaid program. Opposition to wholesale reform will come from the private insurance industry; the private, profit-making hospitals; the American Medical Association; and some segments of the health care industry (Kemper & Novak, 1992). MYTHS AND REALITIES OF CANADIAN AND AMERICAN HEALTH CARE SYSTEMS
Although no current system is perfect, the Canadian model is certainly closest to being feasible and acceptable for our country. As the debates heat up, there will likely be intensification of a propaganda campaign by conservative interests opposing a national single-payer, universal access, comprehensive health plan. There170
fore, social workers need to understand the Canadian system better to counter the arguments that will no doubt be made against it. Myths and exaggerations about Canada abound (Rae, 1992). They include the assertions that people wait a long time for services, that services are rationed, that government is intrusive, that physicians and consumers have limited choices, and that technology is lower. The reality is that many, if not most, Americans also wait, suffer greater effects of government regulation and scrutiny, have limited choices, and suffer the harms as well as the benefits of high-technology medicine. However, polls indicate that Candians are happier than Americans with their health care system. (See the videos Borderline Medicine, 1991, and Critical Condition, 1992, and the report by the General Accounting Office, 1991, for comparisons between the Canadian and U.S. health care models.) COALITION-BUILDING AND GRASSROOTS ACTIVISM
Several major campaigns are under way to influence the Democratic party platform and fall presidential and congressional campaigns. As ofJune 1992, the Democratic leadership have supported middle-of-the-road pay-or-play plans. Work needs to be done to convince them to promote comprehensive reform. The National Mental Health Leadership Forum, a federation of 37 organizations including NASW, and the National Mental Health Association (1991) are actively working to ensure that health care reform treats physical and mental health care equally ("Parity Sought," 1992). The time for achieving fundamental national health care reform is now. The constituency and leadership for such a move are growing. However, two opposing concerns—a sense of urgency that we must not let the opportunity for reform pass us by again and the determination to achieve an equitable, comprehensive, and cost-effective bill—pull supporters in opposite directions. Many people remember that the time for national health care reform came and went in the early 1960s and came and went again in the
HEALTH AND SOCIAL WORK / VOLUME 17, NUMBER 3 / AUGUST 1992
middle to late 1970s. Some of these people will support the notion that something is better than nothing and will work toward or accept a health care plan that makes limited, incremental change. If we grab at the bill that will pass most easily through Congress, we may end up with a poorly conceived and ultimately inefficient and ineffective program. On the other hand, if we hold out for the perfect plan, the time for reform may pass us by again. We cannot afford to wait, but we must not compromise basic principles. Progressive provider and consumer groups must organize and advocate for comprehensive national health care while the climate is right.
References Borderline medicine [Video]. (1991). (Available from WNET, P.O. Box 2284, South Burlington, VT 05407). Critical condition: The American health care forum [Video]. (1992). (Available from Film for the Humanities, P.O. Box 2053, Princeton, NJ 08543.) Families USA Foundation. (1991). Health spending: The growing threat to the family budget. Washington, DC: Author. General Accounting Office. (1991). Canadian health insurance: Lessons for theUnited States. Washington, DC: Author. Gorin, S., & Moniz, C. (1992). The national health care crisis: An analysis of proposed solutions.
NATIONAL HEALTH LINE
Health and Social Work, 17, 37-46. Iglehart, J. K. (1992). American health care system. The New England Journal of Medicine, 326, 962-967. Kemper, V., & Novak, V. (1992). What's blocking health care reform? Common Cause, 25, 8-12. Mizrahi, T. (1991). National health line. Health and Social Work, 16, 151-153. National Association of Social Workers. (1990). Cost analysis of the NASW national health care proposal. Silver Spring, MD: Author. National Association of Social Workers. (1992). Health care reform [Legislative Update]. Washington, DC: Author. National Mental Health Association. (1991). Access to health care: NMHA speaks. Washington, DC: Author. Parity sought for mental health benefits. (1992, May). NASW News, p. 6. Rae, B. (1992, April). Canadians are healthier. Washington Post, p. A21. States taking lead on health care reform. (1992, May). NASW News, p. 12.
Summaries of the NASW National Health Care Plan and bill, tost analysis, and financing plan can be obtained from the National Association of Social Workers, 750 First Street, NE, Suite 700, Washington, DC 20002-4241.
171
NATIONAL HEALTH LINE TERRY MIZRAHI
TOWARD A NATIONAL HEALTH CARE SYSTEM: PROGRESS AND PROBLEMS National health care reform has come a long way since I wrote about it in this column a year ago (Mizrahi, 1991). Social workers have continued to play a major role in promoting a singlepayer, universal system of comprehensive health and mental health care at the national and state levels. The National Association of Social Workers (NASW) has maintained its leadership on the federal scene. On June 9, Senator Daniel K. Inouye introduced NASW's bill, the National Health Care Act of 1992 (S. 2817), to the Senate. This column will present some of the reasons for the mushrooming political interest in health care reform, analyze some of the legislative approaches to the crisis in health care cost and access, identify some of the major bills being considered by Congress, highlight the NASW health care bill, and discuss some strategies to influence the health care debate. CHAOTIC AND COSTLY HEALTH CARE SCENE
The momentum for legislative change at the national level seems to be growing. Whether this can be hailed as a progressive health reform movement remains to be seen. But this type of activism from disparate and ultimately competing (if not conflicting) interests has been placing health care on the front pages. Perhaps the turning point was the upset victory of Pennsylva-
nia Senator Harris Wofford in November 1991. One of every three votes cast for him was reported to be based on his position that health care is a right (Kemper & Novak, 1992). The depressed economy, with increasing unemployment and lack of growth, bas contributed dramatically to the growing concern about health care. The number of uninsured and underinsured people grew as companies cut back or eliminated their health benefits this past year. A public citizen survey showed that the number of Americans without insurance increased by 1.3 million between 1989 and 1990, with 74 percent of them earning more than $25,000 (Kemper & Novak, 1992). At the same time, the burden on American families to pay the greatest share of the national health care bill increased to $6,535 per family, of which $4,296 is actually paid by the families and the rest by businesses. Families pay 32 percent of the $4,296 directly out of pocket; general taxes pay 40 percent, insurance premiums pay 17 percent, and the rest (12 percent) is paid by Medicare payroll tax and premiums. Aggregate U.S. health spending by families (two-thirds of all health spending in 1991) has increased even faster than the average health spending per family. Average family spending increased 147 percent since 1980; the total payments by families increased 193 percent between 1980 and 1991. Moreover, since 1980, health cost increases far
CCC Code: 0360-7283/92 $3.00 ©1992, National Association of Social Workers, Inc.
167
outpaced increases in family incomes (Families USA Foundation, 1991). Between 35 million and 38 million Americans are uninsured, and another 50 million to 60 million people are underinsured. (The latter group holds bare bones health plans with major restrictions or uncovered services.) Sixty percent of poor people are not covered by Medicaid, and only one million of 30 million senior citizens have coverage for long-term health care. In 1990, about one-quarter of American women received no prenatal care, a figure that has risen 50 percent since 1980, when President Reagan took office (Borderline Medicine, 1991). The lack of coverage for mental health services in this country is abominable by almost any standard. The National Mental Health Association (1991) pointed out that of the 153 million Americans with some private health insurance coverage, access to mental health services is much more restrictive than physical health services. Inpatient and outpatient benefits are far less comprehensive, maximum benefits are lower, deductibles and coinsurance are higher, and the percentage reimbursed is substantially smaller. Yet the United States is number one in health care spending. It is estimated that we will spend $800 billion in 1992. Spending has been projected at more than $1.4 trillion by the year 2000. Government expenditures for health care as a percentage of all federal spending increased from 12 percent ($69 billion) in 1980 to 15 percent ($191.5 billion) of the much larger 1990 budget (Iglehart, 1992). Recognizing that this country ranks 17th in life expectancy and 22nd in preventing infant mortality, one can question whether we are getting our money's worth. GETTING ON THE HEALTH BANDWAGON
From the more than 300 health care bilis that have been introduced as of April 1992 in the 102nd Congress, it appears that almost everyone has climbed on the health bandwagon. Liberal union and consumer groups have been joined by groups as diverse as physicians, the health 168
insurance industry, and the business communis. Reasons compelling such involvement vary. Different definitions of the problem lead to different solutions, yet all the groups seem to altree that the federal government must take the lead in providing the solution or in ensuring that the private sector does. Health proposals are usually grouped into three types, moving from minor to major change. The least change is found in the limited smallgroup market health insurance plans; the middle ground is found in the employer "play or pay" proposals that require employers to either provide basic coverage for their employees or pay the government a tax to insure their employees under a public program. The most comprehensive change—the single-payer system—promotes universal health care under one program (see Gorin & Moniz, 1992, for an analysis of these approaches). Smalt-Group Market Reform
Progressive groups, including NASW, are actively opposing small-group market health insurance reform as represented by bilis submitted by Senator Lloyd Bentsen, Representative Dan Rostenkowski, and Senator John H. Chafee. These proposals attempt to increase access to health care by enabling small businesses (usually fewer than 50 employees) to purchase private insurance. This is a prime example of illusive "reform" in that these proposals do not address rising health care costs. They provide no guarantee that health coverage is affordable or comprehensive, and they do not cover other needed services. There usually are high out-of-pocket costs for consumers, and these proposals eliminate many of the consumer protections that now exist in state law. Mandated benefits (including mental health), requirements for the managed care industry, and regulation of utilization review are eliminated. Finally, the proposals continue to use the private insurance model, with its extremely high administrative costs (33.5 cents to 73 cents versus 2.5 cents per health care dollar for Medicare) (National Association of Social Workers, 1992).
HEALTH AND SOCIAL WORK /VOLUME 17, NUMBER 3 /AUGUST 1992
Pay or Play and Bare Bones Approaches
NASW Health Plan: The Best of the Possible
Pay or play and bare bones proposals cover all businesses, so they are broader in scale than the small group plans. They include the Democratic leadership's bills S. 1227 (Health America: Affordable Health Care for All Americans) and H.R. 3205 (Health Insurance Coverage and Cost Containment Act of 1991). However, these proposals continue the same employer-based system and use of costly private insurance. They do little to contain health care costs. This approach results in a shift of higher-risk employees to public programs, maintaining a two-class system with differential access and quality for those with and without private insurance.
NASW has a detailed cost analysis and has calculated the financing and spending estimates accompanying its health plan. The NASW plan as a single-payer system has some unique features in addition to the components it shares with the other current bills. It provides for a full range of mental health services, includes a proposal for long-term care, and encourages the coordination of care through the development of nonprofit "integrated health service plans." Care coordination is also provided for individuals with multiple, costly health problems and is mandated as part of long-term-care benefits. This plan incorporates a strong emphasis on community-based outpatient programs, health care planning, and consumer involvement at all levels. The cost analysis by NASW includes estimates with and without limited cost-sharing and longterm-care benefits. The current cost of U.S. health care services is estimated to be $738 billion for 1991 and approximately $800 billion for 1992. NASW estimates that its NASW plan, including long-term and dental care, would increase national health expenditures to $742 billion in 1991 dollars. The slightly greater cost reflects a projected increase in use of ambulatory care; dental care; and other professional services, including those of social workers and psychologists. Most important to consider are NASW's projections over the next decade. If the current health care system remains unchanged, it is expected to cost $1.959 trillion, or 15.5 percent of the gross national product in the year 2002. NASW's plan, including long-term care, is projected to cost $1.762 trillion in 2002, almost $200 billion less. Other estimates indicate that a single-payer system can save up to $600 billion a year. Moreover, the annual rate of inflation of health care costs under the current system is 9.5 percent; under NASW's plan it is expected to drop to 7 percent (National Association of Social Workers, 1990). These cost projections contain conservative estimates on savings. They do not include what
Single Payer Approaches -
Comprehensive, universal approaches are supported by social workers and other consumer, labor, and public interest groups. Single-payer proposals are financed primarily .through progressive taxation, administered by states, that would pay all providers, thus eliminating the approximately 1,500 private insurance companies. Bills introduced by Representative Marty Russo and Senator Paul Wellstone most closely approximate the ideal financing model. (It is important to note that none of these health reform mechanisms drastically changes the service delivery system or appreciably alters the power relationships in health care.) The progressive aspect is that these proposals provide comprehensive health and mental health coverage under one program, using the current mix of public and private providers. They eliminate consumer out-of-pocket costs and control costs by curtailing waste, regulating provider fees, and establishing global budgets for hospitals. Consumers are still free to select their providers. For hospitals, they eliminate most administrative overhead and paperwork such as billing, collecting, and the completing of multiple forms of different insurance companies. Also, by guaranteeing payment, they eliminate the need to recover costs for uncompensated care through cost-shifting or deficit spending. NATIONAL HEALTH LINE
169
are expected to be significant long-term savings resulting from expanded health promotion and prevention activities (especially as related to prenatal and child health) and from anticipated lower rates of inflation in health care costs. Fears of increased taxes for consumers appear to be unfounded. By eliminating almost all out-of-pocket health care spending, NASW estimates that 80 percent of families and individual senior citizens (and 60 percent of senior married couples) would spend less than or the same as they now spend on these out-of-pocket costs for uncovered services, premiums, deductibles, and coinsurance. Parallels at the State Level
Movement for health reform at the state level remains strong. The different initiatives mirror the variety of approaches at the federal level. Minnesota passed a bill in April 1992 that, although not a single-payer plan, is considered a first step toward health care reform and universal coverage. Twenty-two states are promoting progressive measure ("States Taking Lead," 1992). However, there is also a move afoot to promote bilis like the one passed in Oregon. Considered a rationing proposal, it raises questions about the trade-offs involved in eliminating certain covered services from Medicaid in exchange for including more people in the Medicaid program. Opposition to wholesale reform will come from the private insurance industry; the private, profit-making hospitals; the American Medical Association; and some segments of the health care industry (Kemper & Novak, 1992). MYTHS AND REALITIES OF CANADIAN AND AMERICAN HEALTH CARE SYSTEMS
Although no current system is perfect, the Canadian model is certainly closest to being feasible and acceptable for our country. As the debates heat up, there will likely be intensification of a propaganda campaign by conservative interests opposing a national single-payer, universal access, comprehensive health plan. There170
fore, social workers need to understand the Canadian system better to counter the arguments that will no doubt be made against it. Myths and exaggerations about Canada abound (Rae, 1992). They include the assertions that people wait a long time for services, that services are rationed, that government is intrusive, that physicians and consumers have limited choices, and that technology is lower. The reality is that many, if not most, Americans also wait, suffer greater effects of government regulation and scrutiny, have limited choices, and suffer the harms as well as the benefits of high-technology medicine. However, polls indicate that Candians are happier than Americans with their health care system. (See the videos Borderline Medicine, 1991, and Critical Condition, 1992, and the report by the General Accounting Office, 1991, for comparisons between the Canadian and U.S. health care models.) COALITION-BUILDING AND GRASSROOTS ACTIVISM
Several major campaigns are under way to influence the Democratic party platform and fall presidential and congressional campaigns. As ofJune 1992, the Democratic leadership have supported middle-of-the-road pay-or-play plans. Work needs to be done to convince them to promote comprehensive reform. The National Mental Health Leadership Forum, a federation of 37 organizations including NASW, and the National Mental Health Association (1991) are actively working to ensure that health care reform treats physical and mental health care equally ("Parity Sought," 1992). The time for achieving fundamental national health care reform is now. The constituency and leadership for such a move are growing. However, two opposing concerns—a sense of urgency that we must not let the opportunity for reform pass us by again and the determination to achieve an equitable, comprehensive, and cost-effective bill—pull supporters in opposite directions. Many people remember that the time for national health care reform came and went in the early 1960s and came and went again in the
HEALTH AND SOCIAL WORK / VOLUME 17, NUMBER 3 / AUGUST 1992
middle to late 1970s. Some of these people will support the notion that something is better than nothing and will work toward or accept a health care plan that makes limited, incremental change. If we grab at the bill that will pass most easily through Congress, we may end up with a poorly conceived and ultimately inefficient and ineffective program. On the other hand, if we hold out for the perfect plan, the time for reform may pass us by again. We cannot afford to wait, but we must not compromise basic principles. Progressive provider and consumer groups must organize and advocate for comprehensive national health care while the climate is right.
References Borderline medicine [Video]. (1991). (Available from WNET, P.O. Box 2284, South Burlington, VT 05407). Critical condition: The American health care forum [Video]. (1992). (Available from Film for the Humanities, P.O. Box 2053, Princeton, NJ 08543.) Families USA Foundation. (1991). Health spending: The growing threat to the family budget. Washington, DC: Author. General Accounting Office. (1991). Canadian health insurance: Lessons for theUnited States. Washington, DC: Author. Gorin, S., & Moniz, C. (1992). The national health care crisis: An analysis of proposed solutions.
NATIONAL HEALTH LINE
Health and Social Work, 17, 37-46. Iglehart, J. K. (1992). American health care system. The New England Journal of Medicine, 326, 962-967. Kemper, V., & Novak, V. (1992). What's blocking health care reform? Common Cause, 25, 8-12. Mizrahi, T. (1991). National health line. Health and Social Work, 16, 151-153. National Association of Social Workers. (1990). Cost analysis of the NASW national health care proposal. Silver Spring, MD: Author. National Association of Social Workers. (1992). Health care reform [Legislative Update]. Washington, DC: Author. National Mental Health Association. (1991). Access to health care: NMHA speaks. Washington, DC: Author. Parity sought for mental health benefits. (1992, May). NASW News, p. 6. Rae, B. (1992, April). Canadians are healthier. Washington Post, p. A21. States taking lead on health care reform. (1992, May). NASW News, p. 12.
Summaries of the NASW National Health Care Plan and bill, tost analysis, and financing plan can be obtained from the National Association of Social Workers, 750 First Street, NE, Suite 700, Washington, DC 20002-4241.
171
