Laurence J. Kotlikoff writes in the Boston Globe:

BIG NUMBERS, like 45 million uninsured Americans, are hard to grasp. But that number came home to me at a recent conference. The keynote speaker was former Supreme Court justice Sandra Day O’Connor. Her topic was our healthcare system, and her message was personal and anguished.

The gist was that even she lives in constant fear of major uninsured health bills. Not her own — those of her son. He can’t afford insurance because his son — her grandchild — has a preexisting condition.

As I listened, a light dawned: O’Connor and the rest of us with health coverage are also uninsured. We too face terrible, albeit more remote, healthcare risks — the risk that our employer will drop our plan, that Medicare will go bust, that our plan won’t cover our needs, that premiums will eat us alive, that our doctor will stop taking our insurance, that long-term care will wipe us out, and that our uninsured friends and family members will need major financial help.

These risks are entirely avoidable. We can have an efficient, transparent system that includes everyone; treats everyone fairly; covers all the basics, including prescription drugs, home healthcare, and nursing home care; and costs little more than what we now spend. But we can’t get there via the piecemeal reforms that President Bush, most of his would-be successors, and our state governors are advocating.

To clarify, state governors are not necessarily “advocating” piecemeal state-by-state solutions. It’s more correct to say that the states are stepping into the leadership void and crafting whatever solutions they can. Currently on the Right, “let the states do it” is a favorite health care talking point. On the other hand, righties love to point to the failures of several state programs to argue that the same programs would fail at the national level, also.

As Ezra Klein explains here in detail, “providing health care for all citizens is one of those tasks, like national defense, that the states are simply unequipped to manage on their own.” States cannot tackle the underlying cause of the problem, which is that the private health insurance industry and other moneyed interests are setting the rules and calling the shots. Any solutions the states come up with will be no better than work-arounds.

Kotlikoff writes that we seem to be heading “toward a balkanized healthcare system with the old in Medicare, the poor in Medicaid, most workers in employer plans, and the losers — the otherwise uninsured — in highly subsidized, limited-coverage plans. Loser plans.” But as we’ve seen with the S-chip controversy, right wingers don’t even want to pay for the “loser plans.”

Although he seems to understand the problem, Kotlikoff’s “solution” is for Washington to hand out vouchers that people can use to purchase health insurance. The private health insurance industry and other moneyed interests would still setting the rules and calling the shots. Not a solution, I say.

But his larger point is one politicians, particularly those in Washington, need to wake up to. The health insurance crisis is no longer just a matter of poor people, or the unemployed, being left uninsured. The health insurance crisis has spread to the middle class. If even a former Supreme Court justice is worried, it is spreading to higher-income citizens as well.

Righties are still pretending that people without health insurance are somehow all poor and undeserving. The uninsured are supposed to be content that, at least, if they get really sick, and treatment can no longer be postponed, they can show up at an emergency room and wait most of a day to see a doctor so they can be “stabilized” and sent home. I don’t expect the hard core Right to see the problem until they’re the ones dumped out of the system, leaving them one aneurysm away from death or financial ruin.

According to a recent CNN/Opinion Research Corporation Poll, 64 percent of Americans think government should provide a national health insurance program for all Americans, even if this would require higher taxes, and 73 percent think that government should provide health insurance for all children under the age of 18.

In 1988, Michael Dukakis made health care reform an important part of his platform. Back then, most middle class Americans were still paying only a small deduction from their paychecks for insurance plans that let them see any doctor they wished without worrying about networks. I remember that when George H.W. Bush was asked about healthcare reform, he looked somewhat baffled and said (all together now) “America has the best health care system in the world,” and he didn’t understand why Dukakis wanted to fix something that wasn’t broken. I think, back then, most middle class Americans bought that argument.

And in 1993, when the Clintons brought out their health care plan, the insurance industry’s “Harry and Louise” ads effectively frightened people to stick by the status quo. I had problems with the Clinton’s approach, but it’s interesting to me that the Right still speaks of it as a failure. It didn’t fail, because it was never tried. What is failing is the status quo.

I have thought for years that, some day, we’d reach a tipping point at which enough Americans were personally impacted by the failures and inequities of The Best Health Care System in the World that they would be desperate to change it. I think we’ve reached that tipping point. Even corporations are now calling for reform, although they are still talking about a “market-led” system. They can’t yet see that sticking to a “market-led” system is what brought us to this crisis, and all the “market-led” solutions amount to using tax dollars to keep the “private” health insurance beast alive. People are so invested in “government is not the solution” ideology that they make government the solution for maintaining a failed “private” system.

And even the states, the “laboratories” of new policy, are hamstrung by right-wing ideology. In today’s Los Angeles Times, the speaker of the California Assembly, Fabian Nuñez, describes the fight within the Golden State:

In the next 15 to 18 days before the Legislature adjourns, the narrow window of opportunity we have to achieve healthcare reform in California — reform that expands access for those who don’t have health coverage and keeps costs down for those who do — will start to close. If history is a guide, we can expect an anything-goes campaign in the next few weeks to delay, derail and demonize healthcare reform. We need to focus on some basic truths to keep that campaign from succeeding.

First, for nearly 10 months now, the reform proposals I put forward with Senate President Pro Tem Don Perata have been vetted in the legislative process, fiscally analyzed by academics and scrutinized by the media. Yet you can count on opponents saying, “We’re moving too fast; let’s slow down.” Practically speaking, what they are really trying to do is kill any reform — delay means death to controversial big-issue legislation. Given more time, the forces against healthcare reform will find ways to take more potshots at the proposals. We don’t need a special session of the Legislature later this year. We don’t need to punt to the 2008 election year.

After a discussion of various proposals, he continues,

Those who want to see more complete coverage also will object to our plan because they’d rather see a single-payer system — in which a government-run entity contracts with doctors and hospitals and handles all claims.

I embrace the idea; it is a noble goal and may one day prove to be the ultimate answer. It’s overwhelmingly supported by legislative Democrats and has growing support from Californians. But in 2007, a single-payer plan would be vetoed by the Republican governor just as he did the version the Legislature sent him in 2006. Sacrificing the good for the perfect doesn’t make sense in the world of public policy.

That’s the tune we’re all singing. Most Americans know what the solution to our problem is. What’s standing in the way is the Right. And the Right has so dominated politics in recent years that even progressive politicians are inhibited from bringing the the solution they really want to the table. Instead, they patch together something less comprehensive and less workable and hope it won’t be completely eviscerated by the Right before it comes to a vote.

And then, when the state program fails, the Right will point to it and say, see? Government doesn’t work.

Regarding S-chip, Bob Herbert writes in today’s New York Times:

The program is popular because it works. It’s cost effective and there is wide bipartisan support for its expansion. But President Bush, locked in an ideological straitjacket, is adamant in his opposition.

In addition to the new rules drastically curtailing the ability of governors to expand local coverage by obtaining waivers from the federal government, the president has threatened a veto of Congressional efforts to fund a more robust version of the overall program.

“It’s stunning,” said New York’s Gov. Eliot Spitzer. “He says he’s going to veto health care for kids because it’s too expensive at the same time that these continuing resolutions for the war, where we don’t even know what the cost is, are going through unabated. This is insanity.

“Everybody agrees this is the right thing to do except the Bush administration.”

States want to expand S-chip to middle class children not to undermine health insurance industry profits, but because more and more middle-class children are uninsured.

Wherever there are large numbers of families without coverage, you will find children who are suffering needlessly and, in extreme cases, dying. They don’t get the preventive care or the attention to chronic illness that they should.

“That has not only an immediate effect on their development,” said Mr. Spitzer, “but a long-term cost to society that is incalculable.” …

… Administration officials have argued that the CHIP program should adhere closely to its original intent of limiting coverage to families only slightly above the official poverty line. They said there is a danger that families with higher incomes would begin substituting CHIP for private insurance coverage.

The reality is that under the administration’s approach enormous numbers of children in families without a lot of money will be left with no coverage at all, private or otherwise. The expansion of CHIP is the most efficient, cost-effective way of reaching those youngsters.

And here we come to the plain truth:

What’s happening is cruel. Children who should be eligible for CHIP are being held hostage to policies driven by a desire to protect the big insurance companies and an ideology that views CHIP, correctly, as yet another important step on the road to universal health care.

Ronald Reagan, one of the tribunes in the fight against Medicare and Medicaid back in the ’60s, pumped up the warnings against “socialized medicine” by saying that if Medicare becomes a reality “you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”

I wonder what crazy things the ideologues think would happen if CHIP is expanded to cover the children who have no health insurance today.

The whole bleeping nation is being held hostage by right-wing insanity. When’s it going to stop?