President Carter yesterday called for a national health insurance plan whose "ultimate" goal would be coverage for all, though it would move toward that point at a slow, bit-by-bit pace, depending one economic and other conditions.
Though he has been promising to support "universal" health insurance since April 1976 - and in May 1977 said he would have a plan ready early this year - he merely produced 10 often vague health insurance "principles."
He directed Health, Education and Welfare Secretary Joseph A. Califano Jr. - who presented the principles for him while he was at Camp David, Md. - to prepare a more detailed but still "tentative" plan for public discussion late this year.
Califano is then to prepare a set of "alternatives" in early 1979 so the president can make his "final" decision on what kind of bill to send Congress later next year. The administration hopes the bill will be passed in 1980 and take effect in fiscal 1983.
Carter did not promise in his principles to send Congress a single bill that would automatically assure coverage for all. Instead, he stressed a "gradual" approach dictated by "fiscal constraints" and the fear of aggravating inflation.
Califano called this plan - which means asking Congress to enact one piece of national health insurance at a time, as conditions permit - "the only sensible way" in view of economic and political realities.
This feature and others drew the advance ire Friday of Sen. Edward M. Kennedy (D-Mass.) and a coalition of labor, elderly, religious, consumer and two medical groups - the American National Housestaff Assocation (young doctors in advance training who give much of the care at many hospitals).
They called the president's plans "too little and too late" on several grounds. Yesterday Carter gave them another by saying he will ask "many" Amercians to "share a moderate portion" of the costs of insurance.
Such "cost-sharing," as health economists call it, comes in the form of insurance "deductibles" or "co-payments" (like the share of the hospital bill present Medicare beneficiaries must pay). Kennedy and the co-organizer of his new health coalition - the labor-backed Committee for National Health Insurance - oppose it on the ground that it forces some people to forgo treatment they need.
But the president said, "I want to be certain that the plan is consistent with our efforts to control inflation in the heatlh care sector and the general economy," and "the American people would not accept, and I will not accept, any health care plan which is inflationary."
In his 10 principles, the president said his plan:
1. "Should assure" comprehensive coverage for all, including protection against catastrophic expenses - a kind of coverage Califano said is "a possibility" as the "first stage."
2. Should ensure "quality" care and eliminate "substandard" treatment for the poor.
3. Should assure freedom for all in choice of doctors, hospitals and "health delivery systems." That phrase refers to such organizations as prepaid health plans, often known as "health maintenance organizations" (HMOs).
4. "Must" help control inflation by "aggressive cost-containment measures," and strengthen "competitive forces" in health, another reference to HMOs, which compete with fee-for-service doctors.
5. Should be so efficiently designed it will save money in some ways, helping offset its addition to the federal budget - an addition estimated by Califano at $25 billion to $40 billion more than the $76 billion the government now either spends or loses in tax deductions for Americans' health care.
6. Should be "phased in gradually," with consideration of "such factors as economic and administrative experience" before each expansion.
7. Should be financed in multiple ways, including government funding, employer-employe contributions and consumer cost-sharing.
8. Should give the private insurance industry "a significant role," with "appropriate government regulation." This is another phrase criticized by the Kennedy-labor coalition, which wants strict federal regulation rather than any possibility of patch-work state regulation.
9. Should provide "resources" and payment methods to promote major health care reforms, such as expanding ambulatory (rather than hospital bed) care and prevention.
10. Should assure consumer representation "throughout."
The president said his plan, when he finishes it, will be the "cornerstone" of a policy that improves everyone's health. Califano said health insurance will be the "centerpiece" of Carter's domestic program.
The president's principles were called "a good start" yesterday by the Health Insurance Association of America, representing private health insurers, and the Blue Cross and Blue Shield Association, though both wanted to see the details. The plan's caution won a hearty endorsement from the U.S. Chamber of Commerce.
The problem the administration now faces, however, is trying to sell the plan to Congress. The administration knew it faced the opposition of the American Medical Association, which has very effectively worked to stave off Democratic drives for universal health insurances for 30 years. Now opposition will come from the liberal side, too, unless - a hope Califano expressed - an agreement can be forged leading to a new health insurance.