If the Democrats win the White House and take control of Congress, John Kerry could pass his employer-based healthcare plan, which calls for expanding coverage to nearly 95 percent of Americans, including all children, and for a federal insurance pool that would pay 75 percent of "catastrophic" illness bills. Crucial elements might survive even if the GOP continues to control the House--mainly because of forceful backing from pragmatic business leaders. For example, the Chamber of Commerce signed on early to Kerry's pool idea, calling it "a seed for bipartisan reform." In late October the New York Times reported that the Chamber was acclaiming the idea as "a worthy concept, an excellent use of federal tax dollars," while some Senate Republicans are pushing it, and "lawmakers and lobbyists say that regardless of who wins the presidential election, Congress will soon take up the idea." To be sure, Kerry's scheme may face attacks by the usual suspects and the lawmakers they buy. One influential critic, the National Business Group on Health, has more than 200 members, including at least a dozen drug and medical-device manufacturers plus three dozen healthcare providers and insurers. A Wal-Mart vice president sits on its board.

Advocating universal health coverage while the GOP controls the White House and Congress would be "tilting at windmills," DaimlerChrysler's Dennis Fitzgibbons told me. Maher said any industry subject to government regulation "has got to be concerned about irritating the regulator," meaning the Bush Administration. A single-payer reform proposal, by seeking to eliminate the insurance industry, he warned in his article, would make it and many other businesses "instant and unnecessary opponents." He recommends other forms of tax-financed universal health coverage that would use the industry. An example would be a system in which employer/employee payroll taxes would finance coverage for the working population, with employees offered several choices of health plans, as the Federal Employees Health Benefits Plan does. A Medicare equivalent would provide for the elderly and nonworking population.

"I don't believe [single-payer] will be achievable in my lifetime," says Ron Pollack, executive director of Families USA. Ideologues "will never support it." Industries heavily invested in the present system "will spend every last dollar to stop it." He recognizes that on "a blank slate," employer-based coverage "absolutely" makes no sense. But "in terms of political feasibility," trying to dismantle the present system would make matters "much worse," he told me. "The most important thing is the achievement of affordable, high-quality health coverage for everybody." To him, the crucial question is: "At what point are we willing to say that there's a higher principle in truly moving toward universal coverage than in knocking our heads against a stone wall, in absolute frustration about a methodology [single-payer] that is not going to be achievable in our lifetime?"

Surely in a Republican Washington the prospects for publicly financed universal health insurance are remote. But Washington isn't everywhere. Deborah Richter, a Vermont physician, believes it could still be enacted in every state. As president of Vermont Health Care for All, she's been campaigning to that end in her own state for five years, with impressive results [see sidebar, page 20]. Universal access to affordable, high-quality healthcare should be conceived "as a public good, as are roads, education, and police and fire protection," she says. Making it "a practical issue works. Trying to win support for it by making it a moral issue never works." By resisting the merger of practicality with morality that universal health care embodies, Corporate America is blowing a supreme opportunity to do well by doing good. Enlightened self-interest this is not.

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