Tommy Denton

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Gov. Tim Kaine didn't couch his recent budget amendments as new year's resolutions, but the provisions dedicated to improving health care in Virginia would serve as commendable resolutions that the General Assembly should enact under the current circumstances.

With 1 million Virginians -- nearly one of seven -- lacking health insurance and the rate of infant mortality -- two babies die each day -- among the worst in the nation, Kaine was right to urge dedication of greater public resources to serve those most in need of health assistance.

Kaine's proposal to increase outlays by $100 million for health care, mental health care and other human service improvements, though laudable, is at best modest in a total biennial budget of $73 billion.

Alas, new year's resolutions all shine with the luster of great promise on this side of the annual divide.

Somewhere in the next life, the dearly departed Wilbur Cohen still must be resolving to realize the universal health care system for America he envisioned and worked so hard to achieve when he worked as an adviser to President Franklin D. Roosevelt.

Cohen was the primary architect of Social Security and other social programs of the New Deal. But he realized only part of his dream when President Lyndon Johnson invited him in his twilight years to witness the signing into law of Medicare in 1965 at Independence, Mo., in the presence of Harry Truman, another frustrated advocate of universal health care.

Now Medicare is facing serious financial challenges, but proposed solutions to those conditions have essentially failed the test of the vision and courage exhibited, without ultimate success, by the likes of Cohen, Roosevelt, Truman -- and even Richard Nixon later.

The problem is not merely with Medicare or its companion program for the poor, Medicaid. The problem is with the entire system, which not only has left some 45 million Americans without health insurance coverage but also compiled a record among the world's advanced industrial societies for having the most expensive system yet with regrettably poor health outcomes to show for the investment.

Much of the problem lies in the "commodification" of health care and its systemic practice as yet another entrepreneurial venture.

To criticize the current system is not to condemn it as an evil enterprise. It is simply to recognize that health care delivery in the United States ultimately meets the definition in classical economic theory of market failure.

Those activities that serve the greatest good by a rationally efficient distribution of resources, goods and services provide excellent opportunities for markets to work as they should.

Market failure, however, can be applied to situations in which the inefficiency is particularly dramatic, or when installing nonmarket institutions, such as public policing and firefighting, would be more efficient and thus in the greater public interest than their private alternatives.

All other advanced industrial nations have recognized this fact and provided accordingly in their health care systems.

As Yale political scientist Jacob S. Hacker, author of "The Great Risk Shift," noted recently in an essay on tompaine.com, a "perfect storm" of escalating medical costs, declining median wages and increasing desperation among businesses and industry about health benefits have eroded the scope and generosity of U.S. health insurance.

Hacker's recommended reform calls for creation of a more-or-less universal Medicare-like program for all Americans who do not receive employer-provided coverage. He calls it a public-private partnership. Employers would be required, in lieu of private policies, to make a relatively modest contribution to the program. The self-employed could purchase coverage on the same terms as any other employer.

After the Clinton reform fiasco and six years of hostility in the Bush administration to genuine reform, Hacker offers a pragmatic but inadequate substitute for comprehensive reform of U.S. health care, although any improvement, as offered in Virginia by Kaine, is better than the meltdown that is approaching.

But Wilbur Cohen was pragmatic, too, believing as he did in dedicating the spirit and resources of government as an agent of social progress. His patience and perseverance should inspire more Americans, in their new year's resolutions, to remind each other: We, and those generations to come, are all in this together.

Denton's column appears in the Sunday and Tuesday editions of The Roanoke Times.