Lifelong Health Care -- if the Voters Want It


Los Angeles -- The drive for universal health insurance may be dead in Washington, but here it is alive for at least another month. In fact, plastic California Health Security Benefits cards with the words "Lifetime Care" under the old California Republic bear flag are already being passed out.

PTC The back of the card says the bearer is entitled to: "Lifelong doctor and health care. . . . Your choice of any doctor, hospital, HMO or clinic. . . . Long-term nursing and home health care. . . . Prescription medicine."

Then comes the kicker: "When Prop 186 Passes . . ."

Clever. Proposition 186 on the November 8 state ballot is an initiative that would establish something like the Canadian single-payer health-care system in a state that happens to have more people than Canada does. If Prop 186 wins, the card would allow any legal Californian meeting a residency requirement to walk into any physician's office or hospital without paying a cent.

If it passes, health care in the state would be paid by a 2.5 percent tax on net income, a 4.4 percent payroll tax on businesses with fewer than 10 employees up to an 8.9 percent tax on companies with more than 50 employees, and a $1-a-pack cigarette tax. That works out to $57 a month for a family of four earning $32,000 a year, or $120 a month for the same family earning $60,000.

The sponsors -- which include the AFL-CIO, the American Association of Retired Persons, Consumers' Union and the League of Women Voters -- argue that most families and companies will be paying significantly less in taxes than they are now paying in insurance premiums. (Companies in the state presently pay from 10 percent to 14 percent of payroll for their share of employees' health care.)

The new law, with caps on those tax rates, would pretty much take insurance companies out of the health-care business in California. The result of that, according to calculations approved for the ballot statement, would be to increase the percentage of health-care money actually going to providers from the current 73 percent to 96 percent.

Obviously flushed with success after spending $100 million in advertising and campaign contributions to knock down President Clinton's universal health plan, the insurance companies and other desperately interested parties are ready to do anything they have to do to kill 186. The anti-186 television commercials are being prepared by the same people who brought us "Harry and Louise" -- the advertising agency Goddard-Clausen/First Tuesday -- and estimates are that the opponents will have $25 million to spend overall. (The sponsors of the initiative expect to raise $2.5 million.)

The odds are that Prop 186 will lose -- this year. The anti-186 ads are sure to feature scenes reminiscent of "The Grapes of Wrath," with poor Oklahomans and other Americans (and dread foreigners, too) rushing the borders of the Golden State in search of free health care and oranges. To try to deal with that, the 186 sponsors, organized behind political consultant William Zimmerman of Los Angeles, established a two-year residency requirement for eligibility for long-term care; the state Legislature would be required to set residency requirements for other types and levels of care.

But win or lose, there is a sense that something like this is coming. More than 6 million legal residents of California are without health care, three-quarters of them working full time. There might even be a stealth vote, from insurance company employees who might lose their jobs over this -- and with their jobs goes their own health care insurance, unless there is a real California Health Security Benefits card.

9- Richard Reeves is a syndicated columnist.

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