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Sure cure for health care

President Bush didn't say a word about the moon or Mars during his State of the Union address. He did talk about health insurance. It must have been the polls that brought him back to earth. Listen closely, and you'll hear every candidate addressing the issue. Trouble is, the ones who are speaking most sensibly are either out of the race or were never really in it.

Nothing short of universal coverage will work. For confirmation, read the recent report of the Institute of Medicine, a branch of the National Academy of Sciences, which observed that the lack of health insurance for 43-million Americans is also bad for those who do have it, and concluded that everyone should have it by 2010.

"We all bear the costs of the current nonsystem," the report said. "Doing nothing and maintaining the status quois expensive. The nation suffers losses due to ill health, impaired development, early deaths and lost productivity. The lack of health insurance is a destabilizing factor in families and for health care institutions that serve uninsured patients. In fact, the presence of uninsurance creates insecurity for everyone, even those with health insurance today, because losing that coverage tomorrow is so easy. Universal insurance coverage will benefit all Americans, enhance the great promise of our health care system, and reinforce our values as a democratic society. It is time for our nation to extend coverage to everyone."

The only candidates to propose universal coverage were Dick Gephardt and Carol Mosely Braun, who are out of the race, and Dennis Kucinich and Al Sharpton, whose chances are beyond remote.

Gephardt wanted to require employers to provide coverage, but the issue did not play well for him in Iowa. One likely reason is that Iowans are already better insured than other Americans. Only 8.5 percent of them lack coverage.

Sharpton's plank on the issue calls for a constitutional amendment declaring health care to be a human right. That has no more chance than he does. Kucinich, on the other hand, has a specifically detailed proposal that would essentially extend Medicare to everyone. Our single-payer system for the elderly, which already runs more efficiently and with lower overhead than anything else about health care, would become single-payer for everybody.

This isn't original with Kucinich. Floridians will recognize it as what Sam Gibbons, the former congressman from Tampa, wanted to do.

"Everybody's in Medicare," he once pointed out. "Some of us get it. Others pay."

For not heeding Gibbons, President Clinton blew what looked like the last chance to achieve universal health care. He also lost Democratic control of Congress, for perhaps decades to come. This year marks the 10th anniversary of Clinton's debacle. Rep. Dan Rostenkowski, the departing chairman of the Ways and Means Committee was accurate in pointing out that Clinton, for trying to do business with the health insurance industry, came out with a plan "too complex to understand and so riddled with centrist compromise that it was a recipe for political roadkill."

It bears remembering that the American Medical Association once opposed Medicare as intensely as the health insurance racket is opposed to universal coverage. Today, nobody would dare propose to repeal Medicare. Congress has just broadened it, but only for seniors. The sad part of that, as the Institute of Medicine report implies, is that Medicare would cost even less per capita if new enrollees were as healthy as they should be _ and as they would be if everyone were insured regardless of age.

The president's proposals call for refundable tax credits to help low-income people buy their own insurance and for full tax deductibility for wealthier people who buy catastrophic health care coverage. Bush notably didn't say what this would cost, which would be a lot.

However much that turns out to be, it wouldn't be efficiently spent. The insurance will cost too much. In Florida, the average cost of a small-group family policy is more than $1,000 a month, which is why so few employers are willing to subsidize more than a small part of it.

To make a long story short, the reason insurance costs so much is that not everybody has it. Some don't think they need it; others simply can't afford it. So the dwindling proportion of those who remain in the market are likely to be less healthy and more costly.

Two things are fundamental about health insurance. The more you need it, the less you can afford it. The more who have it, the less it costs. Imagine Medicare as an optional program. Or Social Security.

The only way to make it affordable for everybody is to see that everyone has it _ as a requirement for employers, or as an obligation of individuals (like the Florida law that requires motorists to insure themselves) or as a single-payer system financed by government taxes. Every objective analysis has concluded this would cost less than we're spending now. That is, of course, hardly the only reason why it would be the right thing to do.