Issue Position: Health Care

Issue Position

My views on health care have been shaped by many factors--my experience as an entrepreneur and an employer, among others--but no moment was more important than when I found myself wholly dependent on the help of others for the most basic tasks. The year was 1969. I had just returned from Vietnam, where my life was saved by heroic doctors and nurses in the employ of the United States Government--the very entity so denigrated by opponents of health care reform today. Their care was as excellent as it was compassionate. What I learned--while unable to care for myself, while learning to walk again, while putting my life back together--was that freedom means much less if you don't have your health--and especially if you can't get the care you need to restore it.

I had many things to worry about then, but access to health care was never one of them. And here is the key: Those doctors and nurses were there--as was the Philadelphia Naval Hospital, where I recuperated for nine months, and the many VA hospitals at which I have received care since--because of a federal law. And federal law also gives me a claim on other people's tax dollars to help pay for my care. That saved my life. It's that simple. And it ought to be that simple for everyone else.

Since I have entered public life, I have been called on many times to visit people who have been hurt, especially those who have endured an amputation. The experience that causes me the most pain is meeting a family with a loved one who has suffered an amputation and whose insurance does not pay for the care they need. What causes pain is not merely their suffering. It is the knowledge that I have a claim on their income to pay for my prosthetics, and they have no claim on mine. That's not right.

We have a patchwork system of eligibility that would not receive or deserve a single vote in Congress if it were actually understood as an option: You're eligible for health care if you're old enough, poor enough, employed enough, and so forth. The complexity, redundancies and administrative overhead approach the absurd. People say we can't afford subsidies for health insurance, but the reality is that the system we have is rife with so many subsidies that economists have trouble tracking them all. Some insurance companies are allowed to run what amount to scams under which they offer coverage but deny it when you actually need it. This system consumes 18 percent of our gross national product , costs are surging, and there is no means of controlling them. Yet this is precisely the option opponents of reform have asked the Supreme Court to restore.

Instead, I believe health care reform should start with a single criterion of eligibility: being a citizen or a legal, taxpaying resident. The best and most affordable risk pool isn't employment-based. It's the United States of America. Only about 15 percent of us go into the hospital each year, and most of those who do didn't go in the year before and won't the year after. The point is to share that risk. I prefer doing so through a market-based approach that empowers individuals to choose between competing plans based on co-pays and deductibles that we set together. This system of shared risk is the only way to align the interests of providers and patients and prevent eligibility from health care from being decided piecemeal by interest groups--precisely what I saw them try to do in my 12 years in the Senate--rather than organizing together as Americans. By severing the link between employment and health care, we can free entrepreneurs to create jobs without the worry that they won't be able to afford health coverage for their employees. I know from my own experience as an employer that the economic growth resulting from that alone would help to offset costs substantially

The transparency of this approach would have been far preferable to the Affordable Care Act. That system is preferable to the status quo--it would be hard not to be. The most intractable problem of the Affordable Care Act is that it was passed on a narrow, party-line basis and is therefore unsustainable. Ideally, so important a bill should have been passed with broad, bipartisan and public support. That is why I broke with my party and endorsed the Republican health care reform bill sponsored by Senators Bob Dole and John Chafee in 1994, a time of intense pressure to toe the partisan line.

It's also why my own health care reform plan, Health USA, was based on dozens of meetings with Nebraskans, whom I wanted to empower to write the law themselves rather than acceding to the lobbyists and special interests. It's quite exciting to me to help Nebraskans understand that they've got the capacity to write a law even though they, like me, aren't lawyers. Involving Nebraskans in writing the law is part of a very strong believe I've got in making every effort possible to ensure we have government of, by and for the people. As a lifelong beneficiary of federal law, I know a law as important as health care reform shouldn't be written any other way.

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