Michael Dukakis campaigns during the 1988 presidential election race.

Michael Dukakis campaigns during the 1988 presidential election race.

This Date in UCSF History: Health Care Plans Debated


This story originally appeared in Synapse - The UCSF Student Newspaper, Sept. 22, 1988

“A window of opportunity,” was the catchword of the evening at the Community Health Coalition's California Health Plan forum held Sept. 6 in Toland Hall.

The window alluded to is the 1988 presidential election. For various reasons, the panelists agreed, the election represents a critical juncture in the movement toward improved public access to healthcare: Awareness of the nation’s 37 million uninsured — one in six Americans — is growing.

Federal policy influences the political climate of the state and the return of health issues to the Democratic party platform, after their conspicuous absence in 1984, will keep these topics in the public eye.

AIDS, the crack cocaine epidemic, and the aging of the population imperil our overburdened and fragmented systems of federal and state-sponsored health care.

In California alone, some 17 state agencies are involved in health-care administration, spending approximately $2,000 a year per capita and achieving a level of care and coverage widely considered inadequate.

While the three panelists agreed that changes are mandated, they differed in their approaches to the problem.

Tom Moore, a consultant in health systems financing and organization, observed that from the early 19305, when a movement for National Health Insurance developed, to George Moscone's advocacy of a state plan in the early 19705, Californians have been concerned with equity of access to healthcare.

The state's position as a political and social trendsetter obliges us, Moore said, to establish a system worthy of emulation.

The current system of private insurance supplemented by direct state subsidy of providers is fundamentally fragmented and incapable of containing costs, according to Moore.

He thinks the state should offer enrollment in health maintenance organizations or state insurance for fee-for-service procedures.

Coverage should be comprehensive so that providers will be accountable for the problems of the elderly and be encouraged to advocate preventive care. Moore said providers must be publicly accountable for the costs and benefits of care and that eligibility must be universal.

“Incremental strategies almost invariably cost more than what is gained,” he said, citing Medical and Medicare as negative examples.

Moore was followed by Dr. Jonathan Fielding of UCLA's Health Policy Department, an advisor to Michael Dukakis. Fielding spent much of his time explaining the new Massachusetts “Health Security for All” law, which he helped draft.

This rather complex law, the first of its kind in the nation, promises universal access to the citizens of that state. The burden of payment is assumed first by business and secondarily by the state government.

Moore contended that a forced assumption of responsibility by employers is unfair and dangerous because it makes health care a function of individual and state employment levels.

But Fielding provided evidence of its efficacy. He also supports such state plans as necessary steps in the movement toward universal access.

Governor Dukakis, as Fielding repeatedly pointed out to the enjoyment of the partisan audience, has the ability to compromise, the ability to exert strong leadership and a longstanding, intelligent commitment to health care for all.

San Francisco deputy mayor for health and human services, Myra Snyder, emphasized local issues.

With over 100 federal, public, private and UC facilities in its 49 square miles, San Francisco has the physical resources to care for its people, according to Snyder.

Unfortunately, most of these facilities are concentrated within the more prosperous sections of the city, so care is poorly distributed.

Snyder doubts that those with a vested financial interest in health care, including legislators vulnerable to lobbyists and hospital administrators intent on profit, can be trusted to establish an equitable, effective system.

She contends that a nontraditional, interdisciplinary, small-scale approach to the city's unique health problems is essential.

Mayor Agnos is committed to such a plan, Snyder says. He wants to see an expansion of community-based clinics focusing on outreach programs and outpatient care.

Idealism and hope were the mood of the discussion, which was sponsored by the Community Health Coalition, a San Francisco-based group of community members and health professionals dedicated to improving the quality and availability of health care.