Universal Health Coverage

Universal Health Coverage

Table of Content

Introduction3

Literature Review3

BARRIERS TO UNIVERSAL COVERAGE4

CURRENT HEALTH CARE SYSTEM7

Finding9

MEDICAID AND MEDICARE9

PATHS TO UNIVERSAL COVERAGE12

NASW AND UNIVERSAL COVERAGE14

CONCLUSION16

REFERENCES18

Universal Health Coverage

Introduction

Universal coverage has long been a concern for social workers. During the 1930s the Committee on Economic Health Security, led by Secretary of Labor Frances Perkins, proposed national health insurance (Wencour & Reisch, 1989). Later Wilbur Cohen, assistant secretary of health, education, and welfare under President John E Kennedy, and other social workers played leading roles in the development of Medicare. In recent years, NASW has identified universal coverage as a priority for the profession. In 1993 Sen. Daniel Inouye (D-HI) introduced the National Health Care Act (S. 684,1993), NASW's proposal for a Canadian-style single-payer system (Mizrahi, 1995).

This article examines barriers to and prospects for universal coverage in the United States. The article identifies major obstacles and possible routes to universal coverage, addresses current problems with the U.S. health care system, and discusses the debate over Medicare and Medicaid. The article also discusses implications for NASW and other supporters of a single-payer system.

Literature Review

BARRIERS TO UNIVERSAL COVERAGE

The history of the HSA provides insight into barriers to universal coverage in the United States. Perhaps the chief obstacle is the lack of political support for health care reformers. In 1992, despite polls showing widespread support for universal coverage, Bill Clinton, the only presidential candidate who advocated this goal, received only 43 percent of the vote. From the beginning Clinton faced serious opposition. His effort to enact a modest economic stimulus package failed, and his budget passed by only one vote. He became bogged down by controversy over gay men and lesbians in the military, the Whitewater scandal, and other issues, which prevented him from waging an all-out battle for health care reform.

Health care advocates, particularly supporters of a single-payer system, were also divided (McClure, 1994; McKenzie & Bilofsky, 1993; Rasell & Lillie-Blanton, 1994). The administration had in part designed the HSA to appeal to advocates (Zelman, 1994). The act included universal coverage, comprehensive benefits, and a range of supportive services and allowed the states to create single-payer systems of their own (NASW, 1993a). Despite this, single-payer backers were ambivalent. Although some viewed the HSA as a path to universal coverage and perhaps a single-payer system, others dismissed it as a sell-out to the insurance industry (McClure, 1994). Advocates continually pressured Clinton to change the act, threatening to withhold support if he refused. These demands usually had merit, but many advocates spent more time criticizing or ignoring the act than supporting it. In California single-payer supporters focused on the state's single-payer ballot initiative and failed to respond when Sen. Dianne Feinstein (D-CA) withdrew support for universal coverage. Feinstein's switch "fatally wounded" Sen. George Mitchell's (D-ME) attempt"to build a majority for a revised version of Clinton's plan" (Rothstein, 1995, p. 36).

Social workers also had mixed feelings about the act (Mizrahi, 1995). In October 1993 NASW (1993a) stated that "the Clinton health care plan goes a ...