What happens if the Democratic health plan goes down?

On Jan. 14, 2008, Pat Jarvi was standing in line waiting to get in to a downtown Reno convention hall to hear U.S. Sen. Barack Obama of Illinois, a candidate for the Democratic presidential nomination.

Her interest in the presidential race was prompted by the fact that she was a health care professional.

“I’m an R.N. [registered nurse] … I see some of the flaws in the system and people without insurance and the tough times they go through,” she said.

She had “pretty much” decided to support Obama for president in the Nevada caucuses.

Today, 20 months later, Jarvi is dismayed at the way the issue has unfolded in the nation’s capital and the nation.

“Well, I’m disappointed that health care hasn’t gone as smoothly as it should have done considering Barack Obama won the election and the Democrats have the majority in both the House and the Senate,” she said.

“I’m just disturbed that more people aren’t on board with government involvement in health care because I don’t think the private sector is getting it done.”

She has read much of the Democratic legislation and was taken aback at the dishonesty of criticisms of the legislation.

“Some of the things they’re criticizing are not in the bill. I mean, they’re saying things are in the bill that are not.”

And if the bill goes down to defeat?

“I just think the health care costs will continue to skyrocket so that you’re going to get to a point where individuals—even if they’re covered under their employment—are going to be looking at paying 40 to 50 percent of the cost of their health care in their wages … and I don’t see how people are going to do that. If something isn’t done to curb the rate of health insurance costs, I think you’re going to see the number of uninsured go up and up and up. …

“I’m a nurse, but I’m also a nurse case manager. I mean, I am directly involved with all these people that come in that have no health insurance, and I see what it does to them. I also see what it does to the hospitals. And I think it’s going to be an even bigger problem.”

Critics of the Democratic plan don’t need to worry about the aftermath of its defeat. Their goal is simply to stop the legislation. But people like Jarvi do worry about the consequences.

“Nevada can’t afford to lose any hospitals. We don’t have that many to begin with. And I think just the financial burden on the hospitals, with having so many patients that come in uninsured, it’s going to be catastrophic, especially the rural hospitals like Lyon County and Humboldt General and some of those county hospitals.”

She’s not being alarmist, at least not according to experts in the field. University of Miami health care scholar Steven Ullman was asked on PBS’s Nightly Business Report to describe the consequences of not reforming the health-care system.

“Significant, significant threat,” he said. “You are looking at—from estimates I’ve seen—upwards of 68 million uninsured by the year 2015. You are looking at per capita expenditures for health care going up to about $12,000 for every man, woman and child and in certain metropolitan areas as high as $25,000 for every man, woman and child. That is an untenable situation. It reduces our competitiveness internationally.”

Yet few people are looking beyond legislation in Congress. Last week in Nevada, Republican Mark Amodei announced his candidacy for the U.S. Senate, and Democrat Rory Reid campaigned in Northern Nevada as part of his campaign for governor.

Amodei avoided talking about what would need to be done if the Democratic health plan met with defeat, in part because by the time he took office it would be 2011, and he did not want to look that far forward. He was speaking on the day of President Obama’s health care address to Congress and said, “It’s going to be interesting to see how the deck chairs are arranged after tonight’s speech and then maybe we can narrow that focus on some of those issues, but—you know, Nevada’s one of the highest states, highest states [of] uninsured in the nation, so there are issues that I think we have to take a look at how this works for Nevada and then try to influence federal policy.”

Reid was also reluctant to talk about what might happen if the Democratic bill is defeated, probably in part because he did not want to undercut his father, U.S. Sen. Harry Reid of Nevada, the Democratic floor leader.

“I don’t want to speculate about what’s going to happen here,” the candidate for governor said. “I think that the choice between the status quo and reform is a clear choice, and I think ultimately we’ll choose reform. The question is what the reform will be, and I think it’s better that that reform take place on the national level rather than on a state-by-state basis when it comes to something like health care, and I think that ultimately that there will be health-care reform, and I’ll react to whatever that is rather than speculate about what it might be.”

Don’t governors have to deal with contingencies?

“They do, but I just think it’s premature,” Reid said. “I think that what happens here will happen quickly, and I think we’ll have plenty of time to react to it.”

After the defeat of the Clinton administration health-care plan in 1993-94, some states considered not waiting further on federal action and considered enacting their own state plans. At least four states did so—Maine, Hawaii, Massachusetts and Vermont. A second national health-plan defeat would likely accelerate the number of states who deal with the problem on their own.

“I think it’s worth looking into,” said Jarvi, though she prefers a federal plan. Rory Reid agrees.

“And I believe … that it would be better if we have a national initiative to do this,” Reid said. “I think that would be the quickest and most efficient way to solve some of the problems that we see here in Nevada.”

In new census bureau figures released last week, Nevada and California each had 18.5 percent of health uninsured residents, tying for seventh-worst in the nation. With Nevada expected to endure recession longer than the rest of the nation, its sinking rating probably has not hit bottom yet.