American society is being asked anew to consider where the obligations of individuals and the private sector end in providing health care and where the reponsibilities of government begin. The issue arises from efforts of a new organization, the National Health Care Campaign, which bills itself as a grass-roots group. It is chaired by Arthur Flemming, a former chairman of the US Civil Rights Commission and secretary of Health, Education, and Welfare during the Eisenhower presidency.
The immediate focus of Dr. Flemming's organization is on the requirements of people in financial need: specifically, people in poverty who do not receive medicaid and the millions of Americans who either have no health-insurance plan or are underinsured.
But beyond this focus lies the question of whether this is the opening salvo in a campaign for a national health plan for all Americans, an idea that gained considerable support during the early 1970s. Despite support from major labor organizations and other groups, the concept has been in relative eclipse in recent years primarily because of concerns about the federal budget deficit and the inefficiencies of sprawling federal programs.
The idea of some kind of national health program can be expected to gain a more favorable hearing in next year's Democratic-controlled Congress than in the split Congresses of recent years. Flemming seeks congressional hearings that ``should include consideration of a national health care'' plan. But it is highly unlikely that Congress will approve it, faced with the current rate of annual budget deficits of nearly $200 billion.
The three groups on which Flemming's group turns its spotlight immediately are:
The 15 million children, pregnant women, and elderly who live below the poverty line yet are not receiving medicaid (the federal government's principal method of providing subsidized health care to the financially needy). Congress this year provided that, in any state that agrees, these Americans be eligible for financially underwritten medical assistance through medicaid.
Flemming's group, a coalition of more than 60 national organizations, aims to exert grass-roots pressure on state legislatures to pass laws that would make these Americans eligible for medicaid, although they are not receiving welfare.
Welfare experts and welfare mothers themselves agree that one of the most difficult problems recipients face when they try to get off welfare - and one of the most powerful disincentives - is that accepting a job and leaving welfare means loss of medicaid benefits, although their earnings may still keep them in poverty.
Considerable agreement exists among would-be welfare reformers that some way must be found to permit people, especially single mothers, who are working their way off welfare, to retain at least some portion of medicaid subsidy for themselves and their children.
The 37 million Americans who the National Health Care Campaign says have no health insurance whatsoever, although, according to a new study by the Flemming organization, by 1984 the average American was spending nearly $1,400 a year on health care. ``If we had 37 million persons who were denied access to our education system,'' Flemming says, ``we would regard it not only as a crisis but a scandal.''
In general, he says, these Americans lack health care because they cannot afford to purchase it on their own, and their employer does not have a plan. Flemming's group seeks to exert grass-roots pressure on Congress to hold what he calls ``extensive hearings'' on the issue of full access to quality health care by all Americans. These are the kinds of hearings that conservatives fear could lead to major and expensive changes in some of the nation's subsidized medical-care systems, primarily medicaid and medicare.
The 50 million Americans who, the Flemming organization says, do not have enough health insurance. Extensive health-issue hearings, if Congress were to hold them, presumably would delve into this problem. But whether Congress would feel able to help them, given the mounting budget deficits, is highly questionable.