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An Uninsured Doctor in the House

When Steve Kagen became a member of Congress, he declined health insurance coverage. Now he has a plan to provide it for everyone



Courtesy of Steve Kagen

One of the first things U.S. Rep. Steve Kagen (D–Wisc.) did when he took office last year was to nix his congressional health care coverage. The move stunned a human resources staffer, who, the lawmaker says, looked at him as though he were insane.

"I'll respectfully decline until you can make that same offer for all of my constituents," he says he told her, explaining his decision to turn down what many say is the Cadillac of U.S. health plans.

Kagen, 58, is now one of millions of Americans, including at least nine million children, without health insurance. "I have absolutely no health coverage at all," he told ScientificAmerican.com during a recent interview. "I have no health conditions and am pretty darn healthy." And if he gets sick? "I'd be just like the 47 [million] to 50 million American citizens who don't have coverage," he says, "and I'd have to negotiate with hospitals and doctors for the best-priced coverage."

Until he took office, Kagen, a successful allergist with offices in Appleton and Green Bay, was on the other side of such negotiations. He is now one of nine physicians who traded in their stethoscopes for a House seat—and the only member of Congress to refuse coverage.

Kagen's seemingly brazen act was part of his health care reform strategy. In February he introduced the "No Discrimination in Health Insurance Act of 2008" (H.R. 5449), which would bar insurance companies from hiking rates or denying coverage for preexisting medical conditions. "Nowhere in the Constitution does it say you have a protected right to health care," he says. "But the reverse is more important. You can't be discriminated against because of the color of your skin or your sex, nor because of diseases such as hypertension or diabetes."

His goal: to make health insurance affordable for everyone—and make sure that nobody is left out in the cold. He feels it is crucial to have a federal standard on the books to replace the patchwork of state insurance regulations. "Simply put, if you're a citizen, you're in," he says. "We have federal standards in America for everything ... except the one thing we value most, and that is our health."

In an effort to keep a lid on soaring insurance premiums, Kagen's proposal calls for insurance  companies  to disclose all of their rates. Such a move, he says, would prevent patients from being hit with hidden costs and stir competition that would, theoretically, drive down prices. He says his own analysis shows that the combination of competition and blanket eligibility could cut people's insurance expenses by as much as 20 percent.

But that's still too high a tab for many financially strapped U.S. families. The question is: How are those people going to foot the bill? Not sure, says Kagen, whose legislation does not propose setting aside any federal funds. The key reason, he says, is that there are no reliable stats on such costs.

Ron Pollack, executive director of Families USA, a nonprofit organization in Washington, D.C., pushing for affordable health care for all Americans, calls the measure "a step in the right direction," but notes that ultimately the feds need "to extend public programs or provide subsidies, such as refundable tax credits or some other means" to have truly universal health coverage.

But that doesn't mean that the insured will have to swallow the costs, Kagen says. In fact, he insists that his legislation would actually drive down premiums for everyone, noting that a major reason they are so pricey is that hospitals and doctors charge the insured artificially inflated rates to cover the unpaid bills of the uninsured. There is "a hidden health care tax within every product and every service in America, because of today's discriminatory health care system," he says.

Many, from Kagen to insurance groups, say that will change when everyone has access to coverage. America's Health Insurance Plans (AHIP), a Washington, D.C.-based insurance trade group, has proposed another way to make sure that individuals with preexisting conditions are eligible for reasonable rates. Under its plan, insurers would voluntarily commit to offer those who did not qualify for standard insurance policies the option of buying one at a rate no more than one and a half times the price of traditional packages.

The federal government would still have to fork over funds for those unable to come up with the cost of a premium. But AHIP's Mohit Ghose says universal health coverage would save money in the long run. He says AHIP estimates that it currently costs the government and the insured roughly $50 billion annually to make up for the deficits the uninsured. In contrast, he says, it would cost around $30 billion a year—a whopping $20 billion savings—to cover all Americans under its package.

Ghose says that AHIP does not support Kagen's bill, because it has its own proposal it would like to see enacted. But, he says, the group  backs the emergence of ideas "so we can dissect them and work together to get more Americans covered."

Kagen's measure has 17 co-sponsors (all Democrats) and, in addition to Families USA, enjoys the backing of the American Federation of State, County and Municipal Employees. He acknowledges that it doesn't have a shot at becoming law under the Bush administration, but says he'll boost efforts for passage once the new president takes office in January. Kagen says he hopes that either Barack Obama or Hillary Clinton—whoever nabs the Democratic nod—will be that person, noting that they both have "excellent" health care proposals.

In the meantime, he says, "I hope to be the doctor in the House who helps determine what it is that people need"—at least on the health care front.

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