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a n An to n io In te r -Ame r ic a, San Antonio Intekericall llooldir a nd Literary Festival October 6 9, 1994 Mexican Cultural . Institute, HemisFair Park, downtown San Antonio ange l o . ‘MUStith …………… ::* n’er t iY muchas mas! Daytime readings by Jose AgustM,Armando Joel Davila, Andres Huerta, Hernan Lara Zavala, Gabriel Larrea, Pat Little Dog, E.A. Mares, Marnie Mueller, Harryette Mullen, Abraham Nuncio, Maria Luisa Puga, Jim Sagel, Kalamu ya Salaam, Raul Salinas, Ilan Stavans, Juan Vi Toro, Daisy Zamora, and, by popular demand, San Antonio’s own Nujeres Grandes! “Medicare was passed in the ’60s when Lyndon Johnson was at the height of his powers with the expectation that it would be revi s ited in a few years,” Richardson said. “None of it was done in one session.” He added, “All the problems are going to continue driving the issue. The main problem is there’s a ton of uninsured people and that will continue to drive costs up for the insured people and the taxpayers who support public hospitals…. Costs can’t get under control until we provide care for the uninsured.” Tr MOMENTUM NOW moves back o the states, which can enact their own health-care plans. “Most states got away last year by saying ‘Let’s wait and see what Congress does.’ It’s going to be more difficult to use that excuse,” McGiffert said. California voters have a referendum on universal health care on the November ballot; the health care would be financed with a payroll tax and if it passes, McGiffert feels, it will create more interest in other states. The New Mexico legislature also is expected to consider a single-payer proposal in 1995 that would finance universal coverage through an income tax. ‘ With this sort of movement on the horizon, multistate employers are pressing to keep exemptions from state insurance regulations for self-insured insurers. “We don’t want Congress to do anything to make it more difficult for the states to do their own health care plans,” McGiffert said. In Texas, however, health reformers are in the traditional defensive mode. Lieut. Gov . Bob Bullock has directed the Senate Health and Human Services Committee to look at ways to restructure the state’s Medicaid program to save money. The program already covers children up to age 11 whose families are at the poverty level and it offers health care to pregnant women at 185 percent of poverty and it is operating at a $2.5 billion deficit. Richardson is pessimistic about states’ ability to get a handle on the problem. “A lot of states tried to fix it and ended up with coping mechanisms. I don’t think you can fix it until you do it across the board,” he said. State Rep. Glen Maxey, an Austin Democrat who saw his state single-payer healthcare bill go nowhere in 1993, said the Legislature should be looking at universal coverage and cost controls in the next session. “I’m not having great hopes that the Texas Legislature will adopt a single-payer plan anytime soon, but we can certainly look at it. I am convinced that within a decade we will have it nationally, whether the insurance companies want it or not.” Maxey added that there was general agreement that there was no need to conduct another interim investigation of health care needs. “We’ve had blue-ribbon corn mittee after blue-ribbon committee look at the problem and the answers are there. The question is mustering the political will to do what is neededcost controls, quality controls and market controls.” When the Legislature addresses the Medicaid deficit, which was run up simply covering health care for the poor that the federal government mandates, Maxey said it will offer reformers an opening to expand coverage with the argument that preventive care will save costs down the line. “The only solutions are to raise taxes, do away with Medicaid or reform the system and go to something like managed care,” he said. “Will it be easy? No. Will it be painless? No. We all know universal health care coverage is going to save us lots of money, but in the near term it may cost us some -money and in these kinds of political fights it becomes extremely difficult to put up that money in the near term.” The people lost in the first round of the health-care reform debate. The monied interests shaped the debate brilliantly and played on the native distrust of government, surmounting its distrust of insurance companies. If the conventional wisdom is correct, enough Democrats will be unseated this fall to put off substantial health-care reforms for the balance of the Clinton Administration at least. But the bill is coming due and somebody is going to have to pay it. J.C. Literary Festival is a project of the Guadalupe Cultural Arts Center, 1300 Guadalupe St., San Antonio, N Plus publishers’ displays, booksipings, open microphone readings, public discussions and workshops. THE TEXAS OBSERVER 7