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Universal Health Coverage for America? Depends How You Define It : POLITICAL FORECAST

March 27, 1994

If and when a health-care reform bill is passed, will it contain universal coverage? The Times asked health-care analysts, economists and politicians. Alain C. Enthoven

Professor, Stanford University Graduate School of Business. It will put us on a path that will eventually--in six to eight years--get to universal coverage, provided we define universal coverage reasonably. By that, I mean something like 95%. There will always be some people whose lifestyles and behavior do not fit in with enrollment in a health plan--the homeless and some young people who never believe they ever will be sick. There will always have to be a public-provider system of last resort. I presume undocumented aliens will not be covered by this plan.

The political forecast was compiled by Therese K. Lee. Peter C. Goldmark, Jr.

President, Rockefeller Foundation.

Yes, because that's the political imperative everybody agrees on. Whatever passes, there will be a conspiracy among Democrats and Republicans not to plot out its costs honestly.

It will be passed with some salami-like phases, and that will make the political victory for everyone a lot more diminished. During the 1990s, we'll be in an almost continuous agony of health reform. It was served up like an Epiphany, but it will be dragged out like a soap opera.

Drew E. Altman

President, Henry J. Kaiser Family Foundation It will be said that it does offer universal coverage, and the country will have a big debate about whether it does. We are heading for the great health-care reform finesse that will phase in universal coverage. This will allow the President to claim victory. It will also allow his critics to claim they dramatically modified the President's plan.

The questions are: What are the details? How long to phase it in? Will the phases be written into the statute or left to future actions?

Warren B. Rudman

Former GOP senator, New Hampshire, and co-chair of the Concord Coalition Not now. The cost is higher than anybody is willing to assume. You cannot pick up costs of coverage for 35 million people and figure they will be absorbed by osmosis. Without any new taxes, I don't see how you're going to fund universal coverage.

Robert B. Helms

Director of health-policy studies, American Enterprise Institute. No. But there are lots of ways that people will make it look like we are getting universal coverage. We will not be able to pass universal coverage because of economics. You've got to pass tax increases or hide taxes through some kind of mandates, such as employer mandates. You would have to have huge government subsidies to get universal coverage, and I don't think Congress can afford it.

Steven A. Schroeder

A physician, president of Robert Wood Johnson Foundation. I think we'll get there eventually, but whether it's in 1994 is not clear to me. Most political leaders support universal care, yet everybody seems to find problems with specific ways to get there and it adds up to implicitly favoring the status quo. But this issue is something that's not going to go away.

David M. Eddy

Former Duke University professor and informal member of the Jackson Hole Group, he served on Hillary Rodham Clinton's health-care task force. I think it will be universal in some form. However, it's impossible to say at this time exactly how comprehensive and how universal it truly will be and how long it will take to phase in. There's a basic desire to have everyone covered, but it will be very expensive. It's a political question. And the process is very difficult to predict.

Jack Hadley

Director, Center for Health Policy Studies, Georgetown University School of Medicine. I would like to believe that the President's promise to veto a bill that doesn't have real universal care is a real promise. But he seems to be a compromiser.

It'll be hard to pass a bill that has strong cost-control elements in it. The way the process will get around that is by phasing in cost controls and then universal coverage at a later date.

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