May 7, 1999

Congress's most enthusiastic advocate for establishing a single-payer health insurance system in the U.S. continues to work toward that goal in the face of daunting odds against its success.

Rep. Jim McDermott (D-Wash.) has for the fifth year in a row introduced a bill, H.R. 1200, designed to create a single-payer health care system, similar to the one long used in Canada, that would provide universal coverage for Americans. A key feature of this bill is its death knell for the discriminatory coverage most insurance plans impose on mental health and substance abuse treatment.

In introducing the bill, McDermott, the only psychiatrist in Congress, said, "Our country deserves a health care system that guarantees health care affordability, quality, security, and choice for all Americans." He maintains that his proposal would not only restore control of medical care to physicians and patients, but would also end the precarious state in which the 43 million uninsured Americans find themselves.

He envisions a decentralized system administered by the states but with benefit packages defined by the federal government, which would collect premiums and then pass them on to the states. Americans would be able to choose between HMO and fee-for-service options, both of which would include coverage for mental health care and prescription medications. Treatment precertification would be prohibited "except for case management of catastrophic cases."

In contrast to all the attention paid to health care reform in 1993 and 1994 when it topped the Clinton Administration's agenda, so far this year McDermott has introduced the only comprehensive health care reform bill.

McDermott noted that his bill, known as the American Health Security Act of 1999, would within two years of its passage provide all Americans with health insurance coverage and guarantee freedom of choice in selecting a physician without penalties for going outside of provider networks.

He did acknowledge that his proposal faces an uphill battle. "I am not predicting immediate passage of this bill. Single payer will not pass a Congress that is incapable of even discussing universal coverage," said McDermott, who is known for refusing to mince words for the sake of political expediency. "However, the American people have a right to know about a variety of health care plans-not just the ones advocated by the health care industry and their hired hands. I believe this should be the ultimate goal and the one by which Americans should measure proposals for incremental reform."