Health Care Now

The whole world is in recession. But the United States is the only wealthy country in which the economic catastrophe will also be a health care catastrophe - in which millions of people will lose their health insurance along with their jobs, and therefore lose access to essential care.

Which raises a question: Why has the Obama administration been silent, at least so far, about one of President Obama's key promises during last year's campaign - the promise of guaranteed health care for all Americans?

Let's talk about the magnitude of the looming health care disaster.

Just about all economic forecasts, including those of the Obama administration's own economists, say that we're in for a prolonged period of very high unemployment. And high unemployment means a sharp rise in the number of Americans without health insurance.

After the economy slumped at the beginning of this decade, five million people joined the ranks of the uninsured - and that was with the unemployment rate peaking at only 6.3 percent. This time the Obama administration says that even with its stimulus plan, unemployment will reach 8 percent, and that it will stay above 6 percent until 2012. Many independent forecasts are even more pessimistic.

Why, then, aren't we hearing more about ensuring health care access?

Now, it's possible that those of us who care about this issue are reading too much into the administration's silence. But let me address three arguments that I suspect Mr. Obama is hearing against moving on health care, and explain why they're wrong.

First, some people are arguing that a major expansion of health care access would just be too expensive right now, given the vast sums we're about to spend trying to rescue the economy.

But research sponsored by the Commonwealth Fund shows that achieving universal coverage with a plan similar to Mr. Obama's campaign proposals would add "only"

about $104 billion to federal spending in 2010 - not a small sum, of course, but not large compared with, say, the tax cuts in the Obama stimulus plan.

It's true that the cost of universal health care will be a continuing expense, reaching far into the future. But that has always been true, and Mr. Obama has always claimed that his health care plan was affordable. The temporary expenses of his stimulus plan shouldn't change that calculation.

Second, some people in Mr. Obama's circle may be arguing that health care reform isn't a priority right now, in the face of economic crisis.

But helping families purchase health insurance as part of a universal coverage plan would be at least as effective a way of boosting the economy as the tax breaks that make up roughly a third of the stimulus plan - and it would have the added benefit of directly helping families get through the crisis, ending one of the major sources of Americans' current anxiety.

Finally - and this is, I suspect, the real reason for the administration's health care silence - there's the political argument that this is a bad time to be pushing fundamental health care reform, because the nation's attention is focused on the economic crisis. But if history is any guide, this argument is precisely wrong.

Don't take my word for it. Rahm Emanuel, the White House chief of staff, has declared that "you never want a serious crisis to go to waste." Indeed. F.D.R. was able to enact Social Security in part because the Great Depression highlighted the need for a stronger social safety net. And the current crisis presents a real opportunity to fix the gaping holes that remain in that safety net, especially with regard to health care.

And Mr. Obama really, really doesn't want to repeat the mistakes of Bill Clinton, whose health care push failed politically partly because he moved too slowly: by the time his administration was ready to submit legislation, the economy was recovering from recession and the sense of urgency was fading.

One more thing. There's a populist rage building in this country, as Americans see bankers getting huge bailouts while ordinary citizens suffer.

I agree with administration officials who argue that these financial bailouts are necessary (though I have problems with the specifics). But I also agree with Barney Frank, the chairman of the House Financial Services Committee, who argues that - as a matter of political necessity as well as social justice - aid to bankers has to be linked to a strengthening of the social safety net, so that Americans can see that the government is ready to help everyone, not just the rich and powerful.

The bottom line, then, is that this is no time to let campaign promises of guaranteed health care be quietly forgotten. It is, instead, a time to put the push for universal care front and center. Health care now!