Universal coverage: how to get there.

Last month, I discussed the universal health coverage proposals offered by the presidential candidates. Now let's look at two areas that could help us figure out how to get there: universal health care systems in other countries, and how America's one universal coverage-type program--Medicare--came about.

Earlier this year, PBS broadcast "Sick Around the World" as part of its "Frontline" series, focusing on the health care systems in the United Kingdom, Taiwan, Germany, Japan, and Switzerland. Taiwan's system is based on the Canadian-style national health insurance model, in which private practices are paid by the government; the United Kingdom is the paradigm for the socialized medicine model, in which physicians are salaried government employees; and the other three systems are based on the German model, in which workers pay into "sick funds" to receive coverage from private insurers, and those who can't afford to pay are subsidized by the government.

These plans function fairly well, and their citizens don't pay for health care (at least not directly, though the taxes in these countries are considerably higher than in ours). Insurers are not expected to make a profit.

Whatever the system, each country's premise is the same: Everybody has a right to health care. The money to correct what ails the U.S. system (an estimated $100 billion) is the equivalent of how much the government is spending in half a year in Iraq, according to Princeton University economist Uwe Reinhardt, Ph.D.

But how would we convince Americans that health care for all is worth the cost? Some clues might be found in considering the way in which another costly health program--Medicare--advanced through the halls of Congress. Opposition was everpresent (particularly from organized medicine via the American Medical Association), and it took 8 years and 80 revisions from the introduction of the original bill in 1957 until Medicare became law in 1965.

The preamble to a piece of congressional legislation, the 1966 Comprehensive Health Planning Act, states, "The fulfillment of our natural purpose depends on promoting and assuring the highest level of health attainable for every person."

Once all parties signed on to the idea that seniors needed help in paying medical bills, the question became which mechanism to use--government subsidies, direct government payments, or health insurance financed and administered through Social Security. The latter option prevailed, but these options all sound familiar to what we hear from our presidential candidates today regarding universal coverage.

This pundit has another suggestion: Why not provide a basic layer of health protection for all Americans funded with taxpayer dollars, with any additional coverage paid for by the individual, the employer, or both through the private sector? In this way every citizen will be guaranteed a certain level of health care, while letting market forces take care of levels of health care above a certain floor. This represents a blending of what presidential candidates Sen. John McCain (R-Ariz.) and Sen. Barack Obama (D-Ill.) have advocated.

If there is a recognition that Americans are entitled to health care, Sen. Obama and Sen. McCain would do well to learn from the past endeavors that made Medicare possible and from the programs that exist in other countries. If we fail to learn from history, we are bound to make the same mistakes. Our nation can ill af ford to make these mistakes when we consider the present state of the crisis in availability and accessibility of health care in our country today.

Mr. Zaremski is a health care attorney who has written and lectured on health care law for more than 30 years; he practices in Northbrook, III. Please send comments on this column to imnews@ehevier.com.