Too tough a task?

Tweaking the system to cover health care for all in the state may be possible, but hardly probable

Published: January 17, 2008

Gov. Ed Rendell made an other pitch this week in behalf of his health insurance proposal, "Cover All Pennsylvanians," which is aimed at insuring the estimated 767,000 adults in Pennsylvania who lack coverage.

 Behind the numbers, as the governor sought to demonstrate, are real people facing real difficulties trying to gain affordable access to the health care they or their family members require.

 Unfortunately, this is an old story. Perhaps the only difference today from a few years ago is that more people than ever -- some 47 million nationally -- are uninsured.

 And though our health care system has long relied on employer-provided health insurance, 71 percent of the uninsured in this state are employed, 44 percent of them full time.

 And the trend line is not good. Fewer employers provide coverage, and those that do increasingly are shifting the costs on to employees through higher premiums and co-pays and reduced coverage.

 In short, the system is in crisis. Anyone who fails to recognize that must be living on another planet.

 That does not mean, however, that the problem is about to be fixed, certainly not this year. While most people agree there is a problem, there is a huge divide over how it should be fixed. That has prevented and continues to prevent strong legislative action, either in Harrisburg or Washington.

 States are certainly in a position to tweak the system, and Pennsylvania has been successful in that regard about as much as any other state. But as we have noted here before, there are serious doubts that a state can fix the system with sweeping changes on its own.

 The most recent attempt, in Massachusetts, appears to be falling well short of either expanding coverage to the uninsured or keeping costs within bounds.

 The uninsured are large in number but unorganized. The defenders of the status quo are relatively few but powerful and influential. Guess who is going to win this battle again this year.