y father quit the American Medical Association more than 35 years ago because he disagreed so strongly with the AMA's opposition to Medicare. He had two good reasons to support Medicare. The philosophic reason was that he was a Roosevelt-Kennedy Democrat who believed that government has an obligation to take care of our neediest people. More practically, he was a general practitioner in an old mill city and had many older patients with no health insurance. Back then, Medicare also seemed like a logical first step toward universal coverage.
By the time I became involved with the Medicare program as a member of the House Ways and Means Committee 20 years ago, Medicare had grown into an inviolate adjunct of the Social Security program and provided health coverage for millions of older Americans. Medicare, like Social Security retirement benefits, has had to be changed over the years, principally because of changing demographics. We have all seen the numbers showing how much older the population will be 20 years from now and how the proportion of workers contributing for each beneficiary drawing benefits is going to change. Nevertheless, current projections show that Medicare should be solvent until 2017.
Meanwhile, the ranks of the uninsured in the overall population grow at an alarming rate. Today more than 44 million Americans have no health insurance. Even in a period of unprecedented economic growth, that number has grown by four million since the Clinton-Gore administration took office.
Who are the uninsured? They are the foot soldiers of an economy that is quite different from the American economy when Medicare was adopted. Many of the uninsured are small-business people, home care workers, temporary workers, waiters, farmers, and self-employed consultants. Millions of other families have coverage but pay for it on their own without any assistance from an employer.
It is no wonder that health care coverage has emerged as the dominant issue in the race for the Democratic nomination for president. Bill Bradley has proposed a plan to achieve universal coverage through a combination of private insurance and expanded goverment programs along with tax deductions for individuals who pay for their own health insurance. Medicaid recipients would be enrolled in the same health insurance program that covers members of Congress. Health economists have estimated that the Bradley plan would cost from $55 billion to $60 billion. Bradley argues that this 10 percent increase in government health spending is a small price to pay for a program that makes available affordable health insurance for all Americans, guarantees health coverage for every child, and increases amounts available for long-term care.
Al Gore's health plan is far less ambitious. While expanding coverage for some poor children, Gore's plan would leave 37 million Americans without health coverage. To cover up this problem, Gore has tried to divert attention through media manipulation tactics perfected in this administration. Rule number one has always been, ''When in doubt, attack.''
Gore's attack on Bradley's health plan is particularly unfortunate because it is aimed at fostering intergenerational conflict. Put simply, Gore's argument is that the money Bradley proposes to spend to provide coverage for millions of working American families should be set aside in case there is a problem with Medicare 15 or 20 years from now. That is the same as saying to those millions of Americans: ''Fend for yourselves throughout your working lives and if, by luck, without health care coverage, you live long enough you will have coverage when you retire.'' It makes no sense because it will prevent people from getting the kind of care earlier in their lives that might make it possible for them to live a long time and stay healthy.
As they have in the past, both parties will have to come together to develop bi-partisan means of adjusting Medicare to meet changing needs. That is no reason for us to continue to ignore the huge problems faced by people who do not have any coverage. They deserve a break too.
Bradley's bold and comprehensive plan should be looked at closely, and critics should take their best shots at it. Gore's scaremongering on Medicare will prevent the kind of serious discussion of health policy that should be taking place in this election. It would be sadly ironic if Medicare, a program that Democrats hoped was the first big step toward universal coverage, were to become, in the hands of a Democratic candidate, a campaign weapon that prevented the achievement of that goal.
Medicare has helped millions of Americans because in the '60s we had political leaders with the vision and courage to fight for its enactment. Bradley is the kind of leader who can finish the job.
James M. Shannon is a former Massachusetts attorney general and US congressman.
