May 2001 • Volume 7 • Number 5
Strange bedfellows, same goal: health care coverage for all
BY PAULA BINDER
Rep. Jim McCrery, R-La.Examine their voting records and you'd think they had nothing in common, other than their first name, serving in the House since '88 and serving on the Ways and Means health subcommittee.
Republican Rep. Jim McCrery of Louisiana scored 83 percent "conservative" in rankings compiled by the National Journal -- and he abhors the idea of a government-controlled single-payer health system, in part because it would stifle innovation and development. "Dumbing down" the system, he calls it.
Democratic Rep. Jim McDermott, M.D., of Washington state, a psychiatrist, scored 85 percent "liberal" in the same rankings and for many years advocated the very system McCrery abhors.
And yet they've found common ground and are forging a plan to reform the health system and provide health insurance for all.
The congressmen spoke about reform at an April 4 primary care forum sponsored by the Robert Graham Center in Washington.
Why now?
Back in 1993 - 94, McDermott said, when the Clinton health plan died aborning, about 35 million Americans were uninsured. Since then, he said, "We've had another 10 million people appear on the uninsured rolls, in the midst of a booming economy. It doesn't make any difference where you are on the political spectrum -- you look at it and say, 'Something ought to be done about this.'"
"My passion emanates from a slightly different angle," said McCrery. "It's well-established that a person with health insurance is more likely to seek primary care, preventive care and care at an earlier stage of disease or illness, and therefore be generally healthier than a person without health insurance. So if we're concerned about health care in our country, we would want everybody to have health insurance."
No more patchwork
Rep. Jim McDermott, M.D., D-Wash.But McCrery doesn't want just a tax credit to help the uninsured buy insurance. That would be one more patch on the patchwork that's already there. "What I'd like to do -- and I think Jim shares this -- we want to put everybody into the same system," he said. "But I want everyone in the same system that is managed by the private sector, not the public sector."
McDermott and McCrery first sat down to explore possible points of agreement at the request of a journalist from The Atlantic Monthly (http://www.theatlantic.com/issues/2000/10/miller.htm). "Since we have a basic respect for one another -- though we think the other is totally wrong on politics -- we agreed to do this," McDermott said of the request. As they discussed the options with the journalist, they found a degree of agreement on some basic concepts -- including a move away from employer-based health insurance. (See the story "Key points the lawmakers have been discussing.")
Where there's a will
Of course, galvanizing the political will to create such a system is another question entirely. Some major hurdles would have to be overcome. For example, many people -- both Democrat and Republican -- would resist giving up employer-based health insurance, said McCrery. They'd see it as a "take-away" since the value of employer-based insurance is not taxed.
"We both have huge hurdles to get over in our respective caucuses before we can pass anything like that," McCrery said. "If in fact we are concerned about health care in this country, and if those on my side don't want single payer (or) government control, and those on Jim's side want everybody to be covered and to have some semblance of reasonable health care, seems to me there is common ground that we might build on."
"It's not going to be done by one side or the other," agreed McDermott. "It's going to be done on a bipartisan basis in spite of our hating to be bipartisan, our enjoyment of fisticuffs and throwing bombs and everything else."
This time, that won't work, he added. "This is too big an issue to be solved by one side or the other. Nobody can ram through just what they want. That's why this is an important discussion to have."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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