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COMMENTARY: Health Care -- Still Under The Weather

By Bill Collins

Health plan costs,

Will break me quick;

My only hope,

Is not get sick.

Like the canary in the coal mine, I can detect that Connecticut has a problem

with health care. It's the only subject on which I get any significant amount

of mail (which, for want of time, I callously fail to answer). Much of that

mail is very thoughtful, grappling with the hard question of how Connecticut's

medical services ought to be organized.

Those letter-writers are way ahead of the General Assembly. That body prefers

to limit itself to high-profile citizen revolts, not fundamental issues. And

it doesn't hurt such a revolt to be related to gender-specific female body

parts. Thus the successful reforms of drive-through births and mastectomies,

and the current battle over HMO payments for female contraceptives. But if

your gripe is having no insurance at all, tough.

High-profile issues aside, the legislature is far more concerned with health

cost than health care. Often that concern centers on cutting the Medicaid

budget. One solution is to push people off welfare, in hopes that they'll earn

enough to get off Medicaid too. A second is to hire HMOs to provide Medicaid

administration, maybe more efficiently, maybe more brutally.

But lost in this cost-cutting frenzy, and the hype over women's bodies, is the

question of overall availability. Lawmakers hate to touch that one. Simply

acknowledging that many Nutmeggers have no coverage at all is dangerous. Once

you admit to the crisis, citizens and reporters expect you to do something

about it. That's tough, because all the real solutions have powerful enemies.

Those enemies are mainly the insurance companies, HMO and otherwise. You can

imagine how they would respond to the proposal of a Canadian-style system.

Superior as it may be, it would end the need for those companies. The

advantages are: we would all be covered, employers would no longer need their

own plans, and we could see whichever doctor we wanted. The "disadvantages"

are: we'd pay for health insurance in our taxes, and employers who now offer

no coverage would have to pay their fair share too. No insurance companies

needed, thank you. How did the Canadians ever pass such a thing, anyway?

Other, less drastic, approaches exist as well. Last year, for example, this

column discussed the creation of a statewide non-profit plan to cover all

government workers, and maybe more. Other thinkers suggest that our health

laws should give special encouragement to existing independent non-profit

plans, like Connecticare. Or, alternately, that health insurance providers

ought to become regulated utilities. Then, like water companies, they could be

controlled much more tightly by the state.

Another possibility is the creation of purchasing cooperatives. All the

citizens of, say, Meriden, might be empowered to act in concert, through a

state chartered co-op, to bargain for their own health care.

Suffice it to say, the General Assembly isn't considering any of these ideas.

Sure, it is totally restructuring our massive electricity system, but industry

supports that task. Unfortunately, our wheezing health care system lacks such

wealthy champions. And now, even the heart-tugging sight of untreated children

has blurred, because Washington sent along money to cover a lot of them. But

many more still remain vulnerable, along with hundreds of thousands of adults.

All told, perhaps 15 percent of us still have no coverage. This year, though,

that's not the hot health topic at the Capitol. It's birth-control pills.

(Bill Collins, a former mayor of Norwalk, is a syndicated columnist.)