Health care

Problem: The cost of insurance premiums is going up. Non-generic pharmaceuticals are more expensive. Nearly 100,000 Americans die annually from preventable medical errors, and a million more are injured. The Berkeley School of Public Health reports that the pool of physicians in California is aging rapidly and that the geographic distribution of doctors leaves rural and minority communities underserved. This underscores the biggest shortcoming — the disparate nature of medical services.

Americans spend $2 trillion a year on health care, about 16 percent of the nation’s GDP. This makes it the most expensive in the world. The traditional rationalization — that it is therefore the best medical care in the world—would ring truer if everybody had comparable access to it. Today 45 million Americans lack medical coverage. This does not include illegal immigrants, who typically just show up at the emergency room door, the most expensive portal for delivering health care services.

Politics: The idea that the federal government should guarantee access to health care has been kicked around the Oval Office since Harry Truman was president. He couldn’t get it done, and neither could President Clinton, who lost not only the issue but his Democratic majority in Congress in the bargain. Key Republicans initially embraced universal coverage, but after GOP leaders concluded that inflicting a political defeat on the new president would enhance their chances of taking Congress in the 1994 mid-term elections, they opted against Clinton.

Democrats retaliated by frustrating Bush’s attempted reforms. In 2006, Senate Democrats filibustered a bill that would have capped malpractice awards, as well as a plan to let small businesses pool together to purchase health insurance for their employees.

Solution: It took a governor (naturally) to figure out what Washington hadn’t fully grasped: A disproportionate number of the uninsured are young and healthy, and must be brought into health insurance pools—for one thing, the system needs their premiums. On April 12, Massachusetts Governor Mitt Romney signed legislation making health insurance all but mandatory in his state. It’s estimated this law will bring almost all of Massachusetts’ 500,000 uninsured into a health plan. Vermont followed suit. Will the rest of the nation do the same? Romney hopes so, and he’s using this issue to present himself to the nation as a problem-solver. As a sign of how hungry the nation is for such a leader, Romney has vaulted into the top tier of Republican presidential hopefuls for 2008.

Immigration

Problem: Tourist visas are easy to manipulate, the Mexican border is a sieve, and the laws preventing employers from hiring illegal aliens are impossible to enforce.

If it weren’t for fear of terrorism, one way to look at unchecked immigration might be that it is not a problem at all. Immigrants, especially those from Mexico and Latin America, are coming north to do jobs Americans will not do, enriching our country economically and culturally. The other view is that illegals are cutting in line ahead of those trying to come legally, stretching social services, depressing wages for Americans already at the bottom economic rung, and refusing to assimilate. These two viewpoints are not mutually exclusive.

Politics: Legislation offered in 2006 by Senators Ted Kennedy and John McCain reflected two great realities about immigration. First, there is a market for these workers. Second, there is no practical or humane way to repatriate millions of immigrants who have been living here for years, working, marrying, raising children (and paying taxes). The Kennedy–McCain bill envisioned a guest worker program and a path to citizenship for those already in the U.S. illegally. It was endorsed by the president and passed the Senate. But the majority of House members, sensing anti-illegal-immigrant sentiment among its 2006 election year constituents, rejected the Senate approach in favor of a harsher bill, and the legislation died.

Solution: In 1986, Congress passed immigration reform that was expected to fix all this. "Future generations of Americans will be thankful," President Reagan said as he signed it. But the law did not slow illegal immigration. By the time Reagan signed it, the national identification card envisioned by its authors was stripped out of the bill and employer sanctions were so watered down as to be meaningless. Twenty years later, about 12 million illegal immigrants could qualify for amnesty. "Next time it will be 24 million," warned Georgia Congressman Johnny Isakson. "We will have lost control."

It’s not possible to end illegal immigration, but three or four sensible alternatives present themselves. First, the federal government can pass the legislation it said it was passing two decades ago: a comprehensive approach including a guest worker program, a path toward citizenship for those already here, strict sanctions against employers who hire illegals, and a national ID card using advanced biometric technology.

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