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The disease of uninsurance

The "new disease called uninsurance," as former Surgeon General C. Everett Koop terms it, has become America's No. 1 health problem. Some 37-million suffer already. Everyone else under 65 is at risk, since to have health insurance today doesn't mean you'll have it tomorrow. Job changes, layoffs, early retirements and the simple, soaring unaffordability of coverage are creating as many as a million new victims each year. The shame of it is that this scourge, unlike cancer and heart disease, is entirely preventable. Except for South Africa, every other industrialized nation has long since found a way to provide affordable health insurance to everyone. What stops the United States? There are many reasons, political cowardice among them, but no good ones.

Americans have no more patience for excuses. Almost everyone who depends on public opinion for a living sees changes coming. Even the American Medical Association, for so long the sacred shrine of

the status quo, has come at least partly around. Congress and most of the state legislatures are giving serious thought to proposals, such as the comprehensive bill that some Senate Democrats offered Wednesday, that would have been unthinkable only a few years ago.

The Senate bill, which would require businesses to insure their workers or pay a special tax into a government insurance fund, would indeed result in coverage for everyone, and that would be a marked improvement over the present. But so would almost anything.

One of the best features, as Majority Leader George Mitchell explained them, is that it would do away with Medicaid, which has been intentionally starved for money because of its association with the poor. It would be replaced by AmeriCare, a program covering everyone who is not on Medicare or insured on the job. The virtue here is that health care would finally be regarded as a basic right of citizenship.

But some enormous problems are immediately apparent in the bill. Small employers, who are already largely priced out of the insurance market, could not afford this or any mandatory government program unless some tough cost controls come with it. Large employers, many of whom are now paying as much for health care as they realize in profits, need cost control, too. So does everyone. The Democratic bill proposes to negotiate expense ceilings with various providers _ hospitals, doctors, and so forth _ but it is vague on what happens if negotiations fail. Nor have the sponsors settled how much the government would pay, and what rate of taxes would fund it.

A second drawback is that AmeriCare recipients above the official poverty line would still be responsible for up to 20 percent of premiums, deductibles of up to $500 per family and co-payments of up to $3,000 a year. That's a lot of money for people earning only the minimum wage.

Most conspicuously missing is the cost-saving simplicity that distinguishes the Canadian national health care system. Instead of hundreds or thousands of private insurance plans, each with its different paperwork and overhead, Canadians have just one for each province. They have no co-payments or deductibles, which streamlines billing. They also choose their own doctors, a right currently being denied to more and more U.S. citizens every day.

Another reason the Canadian governments are able to control costs is that they pay almost all the bills. The General Accounting Office told Congress this week that the United States could save $75-billion a year simply by copying the Canadian system, enough to cover every American now uninsured.

What could be so wrong with the Canadian model that congressional Democrats are afraid to emulate it? Enough of the private insurance lobby. And enough of this nonsense about Americans wanting an "American solution." In the broad sense, Canadians are Americans, too.

At least Mitchell and the Democrats have come up with something. There is as yet no sign from President Bush, who takes his free health care as a matter of right, that there is any health problem beyond too many malpractice lawsuits. Dr. Louis Sullivan, the secretary of health and human services, insists a presidential plan is forthcoming. When? How many more families and small businesses must be bankrupted? How many more couples must consider divorce so that a desperately sick child can qualify for Medicaid's miserly benefits?

Senate Republicans imply the Democrats are looking only for a campaign issue. That's both mean-spirited and short-sighted. Sooner or later, someone is going to win a presidential election over the health care issue. If George Bush wants that to be someone else, it's his choice.