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Health Reform Ideas in the Primeval Soup
Unformatted Document Text:  31 As health reform began to appear on the political agenda after 1970, the stories told at Congressional hearings were often ones of financial ruin because insurance did not cover the huge bills incurred with a major illness. A policy idea that found life in a bill introduced by Senators Long and Ribicoff. The bill included other public program expansion for the poor, but the prominent feature was a public catastrophic coverage program financed by a payroll tax. This idea did not generate the discussion of the two major proposals from Kennedy-UAW and the Nixon-Ford Administration, nor did it have the splash of the dramatic Kennedy-Mills compromise. It did have a fair amount of support in the Senate in that dramatic summer of 1974. Wainless reports that there were clearly the votes in the Senate Finance Committee to report out the Long-Ribicoff bill, and that probably a bipartisan majority of conservative Democrats and Republicans would have been available to a similar House version. 76 If we again play the “might have been game”, it appears the policy idea of public catastrophic insurance funded by a payroll tax combined with an expanded public program for the poor might have found a Congressional majority in the Summer of 1974. Whether such a bill could have won on the floor depended on the reaction of the liberal Democrats, who were not in a mood to accept something much less than their preferred alternative. The Carter plan featured catastrophic coverage as a first step toward more comprehensive coverage. External events and a badly divided Democratic party conspired to preclude any real consideration of the Carter plan in his last year in office. In the early 1990s debate the idea of catastrophic only coverage had been eclipsed by the various comprehensive proposals. But, a modified version of the catastrophic coverage idea appeared in the form of the idea of Medical Savings Accounts combined very high deductible insurance. This idea has been advocated and promoted by John Goodman of the National Center for Policy Analysis. 77 This idea has resonated with the conservative health policy advocacy coalition in the last decade. Basic Concepts The Long-Ribecoff idea was to combine public catastrophic insurance financed by a payroll tax combined with a more comprehensive basic public plan to replace Medicaid. The 1979 Carter plan was similar in many respects, except that it explicitly projected eventual expansion to more comprehensive coverage. Implicitly one might assume the Long plan would have eventually evolved into something more comprehensive. The current version of catastrophic insurance is very different. The Goodman-Pauly proposal allows individual families to have a high deductible insurance policy, and 76 Wainless, op. cit. 77 Mark Pauley and John Goodman,”Tax Credits for Health Insurance and Medical Savings Accounts, Health Affairs (Spring 1995), p. 125-139.

Authors: Brasfield, James.
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31
As health reform began to appear on the political agenda after 1970, the stories told at
Congressional hearings were often ones of financial ruin because insurance did not cover
the huge bills incurred with a major illness. A policy idea that found life in a bill
introduced by Senators Long and Ribicoff. The bill included other public program
expansion for the poor, but the prominent feature was a public catastrophic coverage
program financed by a payroll tax.
This idea did not generate the discussion of the two major proposals from Kennedy-
UAW and the Nixon-Ford Administration, nor did it have the splash of the dramatic
Kennedy-Mills compromise. It did have a fair amount of support in the Senate in that
dramatic summer of 1974.
Wainless reports that there were clearly the votes in the Senate Finance Committee to
report out the Long-Ribicoff bill, and that probably a bipartisan majority of conservative
Democrats and Republicans would have been available to a similar House version.
76
If we again play the “might have been game”, it appears the policy idea of public
catastrophic insurance funded by a payroll tax combined with an expanded public
program for the poor might have found a Congressional majority in the Summer of 1974.
Whether such a bill could have won on the floor depended on the reaction of the liberal
Democrats, who were not in a mood to accept something much less than their preferred
alternative.
The Carter plan featured catastrophic coverage as a first step toward more comprehensive
coverage. External events and a badly divided Democratic party conspired to preclude
any real consideration of the Carter plan in his last year in office.
In the early 1990s debate the idea of catastrophic only coverage had been eclipsed by the
various comprehensive proposals. But, a modified version of the catastrophic coverage
idea appeared in the form of the idea of Medical Savings Accounts combined very high
deductible insurance. This idea has been advocated and promoted by John Goodman of
the National Center for Policy Analysis.
77
This idea has resonated with the conservative
health policy advocacy coalition in the last decade.
Basic Concepts
The Long-Ribecoff idea was to combine public catastrophic insurance financed by a
payroll tax combined with a more comprehensive basic public plan to replace Medicaid.
The 1979 Carter plan was similar in many respects, except that it explicitly projected
eventual expansion to more comprehensive coverage. Implicitly one might assume the
Long plan would have eventually evolved into something more comprehensive.
The current version of catastrophic insurance is very different. The Goodman-Pauly
proposal allows individual families to have a high deductible insurance policy, and
76
Wainless, op. cit.
77
Mark Pauley and John Goodman,”Tax Credits for Health Insurance and Medical Savings Accounts,
Health Affairs (Spring 1995), p. 125-139.


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