The Leftward March Toward a Single Payer System

Commentary by Pete du Pont
If at first you don't succeed, take smaller steps and people won't realize where you're going. This is the new motto of the liberal movement, now at the tail end of the Clinton presidency. Learning from him, incrementalism is now seen as their key to victory.

The best example is the crown jewel of the liberal agenda, nationalized health care. In 1992, candidate Clinton promised to reform our health care system by moving towards the liberal ideal. The plan, ultimately designed behind closed doors by the First Lady, called for an intricate and complex web of managed care to provide coverage for all Americans.

Much to their surprise, the scheme was rejected -- first by Congress, then by the voters. But this did not signal the end to nationalized health care. Instead of retreat, the Clintons and the rest of the liberal movement regrouped, and began the slow process of reaching their goal through baby steps. Revealing their strategy, Hillary Clinton told New Yorkers last year, "Now I come from the school of smaller steps." This apparently would reassure her liberal supporters that the goal is still the same, it's just that the rest of the country can't handle it all at once.

After a brief cooling off period, the Democrats decided to try again. And where better to start than with the children. After all, who could be against children? In 1997, the president pushed through the Children's Health Insurance Program (CHIP). CHIP gave the states $24 billion over five years to provide health insurance to uninsured children from low-income families -- basically those in families with incomes below 200 percent of the poverty level.

When CHIP began, the president estimated that approximately five million children would enroll in the program by now. However, only about a million children have actually enrolled. And many of those were not previously uninsured. Rather, they just switched from some other type of coverage -- including private insurance and Medicaid.

Far from being the answer to the uninsured problem, the number of uninsured children has actually gone up. In fact, the Census Bureau reports the number of Americans without health insurance has soared to 44 million, about 11 million of them children. A 1995 survey had put the number of uninsured children at only 9.5 million.

Instead of recognizing CHIP as yet another failed government program, the president argues the problem is that while most uninsured children are eligible for CHIP, their parents just haven't enrolled them. The solution, the liberal theory goes, is to find a way to convince their parents to do so.

This mission has been taken up by Clinton's handpicked successor, Vice President Gore. In laying out his incremental vision for America, candidate Gore has called for an expansion of the CHIP program. Gore would raise the income limit for eligibility from the current 200% of poverty to 250%. He would also expand the program past children to allow parents to enroll too, saying families will be more likely to enroll their children if every family member can have coverage.

Gore doesn't stop with CHIP. He also proposes to allow people between the ages of 55 and 65 to buy into Medicare. He does this despite the fact that Medicare is going broke faster than any other government program, including Social Security. It's also a bad idea because dollar for dollar, Medicare's one of the worst buys in the marketplace.

Why? Because Medicare coverage has holes in it that expose seniors to thousands of dollars of personal expenses. In 1998 for example, 360,000 Medicare beneficiaries faced $5,000 or more in out-of-pocket costs. To avoid these financial risks, a majority of seniors are forced to obtain private insurance to fill the gaps -- either through a former employer or by purchasing supplemental "Medigap" insurance. Thus, Gore would encourage the near elderly to buy inferior insurance when the same dollars could buy better coverage in the private market. Is it any wonder then that the dean of the nationalized health care movement, Sen. Ted Kennedy, recently endorsed candidate Gore?

Throughout it all, there is one consistency: The belief that America should look to the federal government to solve its health care problems. That's why we must be diligent now and in the future to say to those who would take us on the leftward march toward a single-payer system: "It doesn't matter if you take giant steps or baby steps, they're steps in the wrong direction."



The National Center for Policy Analysis is a public policy research institute founded in 1983 and internationally known for its studies on public policy issues. The NCPA is headquartered in Dallas, Texas, with an office in Washington, D.C.