With voters in the 41 primaries and caucuses so far this election season regularly listing health care high among their most important issues, the call for universal health care has been moved to the center of the public debate. In contrast to the 2004 slate of Democratic candidates, both of the remaining Democratic candidates offer similar universal health care plans with minor differences over implementation.

By outside non-partisan estimates, however, both the Clinton and the Obama plans would strive, to their great credit, for universal coverage, but would not likely accomplish that goal.

One of the main reasons for this is that both plans would rely on the private insurance industry to deliver coverage (for some through the Federal Employee Health Benefit plans offered to members of Congress), with the added benefit of expanding an S-CHIP-style program to help low-income working families afford access.

The problem is that a middle-income group of individuals and working families who do not have employment-based insurance, who lack union representation to help them win good employment-based health benefits, and who would not qualify for low-income assistance would likely be forced to purchase health care premiums they could not afford.

Now, of course, both candidates could crunch the numbers and find room for those millions of middle-income folks to ensure they have coverage. This would be a positive step. Expanding union membership through passage of the Employee Free Choice Act, which both candidates have pledged to sign, would also have a longer-term effect of getting more working families on the insurance rolls through employment-based benefits.

Both candidates insist that this mixed style of health care is the best that could be won in a Congress in which Republican votes are required to pass. If that is true, we should get behind it. But it doesn't have to be true, so we should work for something better. (I'll leave it to others to debate whether a Clinton administration would have the political capital to build a bipartisan coalition on universal health care in Congress, having failed once already and becoming a symbol for rancorous, if undeserved, Republican hostility on health care issues as a result.)

Why should we call for something better? These proposals offer only a temporary fix for what is ailing the system.

Universal coverage that relies on the private insurance industry will be subject to the private market's skyrocketing costs of premiums, care, and pharmaceutical drugs. Coverage will simply be more and more expensive unless strong intervention is brought to bear to control costs and limit other problems like cherry-picking, donut holes, and co-pay increases. In the end, the cost to the federal government will climb, unless the dynamic changes altogether.

Neither Clinton's nor Obama's plans, at this point, have a goal of changing that dynamic. (For contrast with the leading Republican 'plan,' check out John McCain's tax-and-uninsure proposal here.)

Medicare for all

A better direction is a Medicare-for-all plan. Oh that's socialized medicine, you say. We can't have that.

Why not? We have socialized public safety and fire departments. Socialized transportation, education, and so on. Why not health care? Why should our health and that of our children be any less a social concern than your neighbor's burning home?

There is no basis for claiming that a Medicare-for-all program would deliver noticeably different care, except in terms of how much you and your boss pays for it. On the contrary, everyone, including the 47 million who lack coverage, would enjoy almost instant and better coverage, and employer and individual/family premium payments would disappear.

By contrast, tens of millions who right now get supposedly higher quality insurance don't get full coverage for things like prescription drugs, mental health care, dental, vision, or high-cost treatments – and they have to wait months sometimes for many treatments that are covered. And when they do seek medical care and use their insurance – heaven forbid – their premiums grow faster.

There are two basic Medicare-for-all type proposals being floated in Congress now. One is co-authored by Rep. John Dingell (D-MI) and Sen. Ted Kennedy (D-MA). This bill would create a two-tier health insurance program: for low-income people, seniors, and others who would like to opt in, Medicare would be expanded to provide them coverage. For others with higher incomes, the Federal Employees Health Benefit program would give them access to a range off private insurers.

Another plan, authored by Rep. John Conyers (D-MI) and advanced by the Dennis Kucinich presidential campaign, would simply eliminate for-profit insurers and expand Medicare to cover everyone. Everyone would have full coverage for any medically recognized ailment.

The difference between the two plans is pretty basic. The Dingell-Kennedy proposal would ultimately narrow the for-profit market and help control costs, but it would also allow private insurance corporations to attract the healthiest and wealthiest people to their plans, while the sickest and poorest would by covered by Medicare.

It is doubtful that any meaningful difference in the quality of care would exist between the two markets, but because the health care industry would still be driven by profit motives, the ability to control costs on the public side would be hampered. Federal costs would likely grow in tune with the whims of the private markets, and political battles over how much investment to put in the public side would create a sense of uncertainty for its beneficiaries.

The best solution is to transition to a single-payer, not-for-profit Medicare system that eliminates huge premium costs for both employers and families, provides full and complete coverage, and restrains the spiraling inflation that puts the health of millions in jeopardy every day in this country.

Health care not warfare

Readers can learn more at Healthcare NOW's web site. Join the ever-widening circle of the Medicare-for-all movement by checking out the Progressive Democrats of America's (PDA) newly launched 'Healthcare not warfare campaign.'

The campaign is co-chaired by Conyers, Marilyn Clement of Healthcare NOW, media expert Norman Solomon, and Donna Smith, the founder of American Patients for Universal Healthcare. Its aim is to organize health care advocates and working families in congressional districts across the country to win support for Conyers' bill.

The campaign's main theme is to link the $10 billion monthly price tag of the war in Iraq to the growing cost of the health care crisis. 'On the fifth anniversary of the start of the Iraq war, nearly one in six Americans has no health insurance, and tens of millions of others are woefully under-insured – while the war continues to skew the US government's budget priorities,” said PDA Executive Director Tim Carpenter in a statement to the press.

“Most lawmakers treat the war and healthcare as separate issues,' he added. 'We intend to make the connection for them and to push for a fundamental shift in their policies and priorities: away from war and toward funding human needs at home.” --Reach Joel Wendland at