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Major social change often takes generations, so it's not surprising that efforts to establish a health care system covering all Americans haven't yet borne fruit. The challenge for someone trying to make a change is how to stay motivated when the change you want might not happen during your lifetime.
As part five of our weekly series on reforming health care, NPR's Julie Rovner profiles one lawmaker who spent his career trying to find that answer.
JULIE ROVNER: At a news conference last December to introduce the Healthy Americans Act, his latest bill to provide every American with health insurance, Oregon Democratic Senator Ron Wyden sounded like a man in a hurry.
Senator RON WYDEN (Democrat, Oregon): Health care has been poked and prodded and blue-ribboned, and it is time for action.
ROVNER: In fact, the 57-year-old Wyden has been pursuing that action since he was in college, that's when he took a job as a driver for then-Senator Wayne Morse. It was the summer of 1968, shortly after the Medicare program began.
Sen. WYDEN: And as we drove around the state, seniors would come up to Senator Morse and say: Senator, you've got to help me. I've had a big hassle with Medicare and haven't gotten paid, and could you give me a hand?
And Senator Morse would look at them and say: Well, Ron here's a bright young guy. He's going to help you out. And I kind of thought to myself, gulped, and said, how in the world am I going to do this?
ROVNER: Wyden eventually found ways to help. That sparked an interest in working with seniors to solve their health care problems. After he finished law school, Wyden founded a senior citizen law service that still operates today. He also co-founded the Oregon chapter of the Gray Panthers.
Sen. WYDEN: And one of the issues that came to my attention very early on was how so many seniors were buying these insurance policies that weren't worth much more than the paper they were written on.
ROVNER: Those policies were meant to supplement Medicare coverage but often people bought policies that duplicated each other, or cost more than they provided in benefits. Wyden worked for and got some reforms passed in Oregon. In 1980, he got elected to the U.S. House and brought the fight to Washington. That's where he discovered that in health care even the smallest of changes can take a lot of time and effort. For example, requiring that insurance policies to supplement Medicare be standardized so people could compare prices and benefits.
Sen. WYDEN: That was a long battle to drain the swamp. And, you know, year after year after year people in private industry would say, oh, Western civilization is going to end if we have some standardization and some reform. And I think we made the case, but it took a decade.
ROVNER: For much of his 15 years in the House, and since 1996 in the Senate, Wyden has pursued incremental changes in the health care system. He's been willing to take small steps, he says, as long as they move toward a larger goal of covering more people and holding down health care costs.
Sen. WYDEN: The health system is almost like an ecosystem, you do something in one corner and it fluffs up everywhere else. And I think the premium is always on trying to help as many people as possible now, but do it in a way that's consistent with sensible, long-term reform.
ROVNER: He did support the broad change proposed by President Clinton. But after that plan failed, he developed a new strategy: Lay low.
Sen. WYDEN: After 1994, I think a lot of Americans looked at the federal government and said, I'm not sure those folks could run a two-car parade, let alone resolve what to do about one-seventh of the American economy, our health system.
ROVNER: But now Wyden is excited about a new window of opportunity. It's not just the public that wants health reform - it's the business community, too.
Sen. Wyden: I mean you've got, you know, businesses in Coos Bay, Oregon, or Denver, Colorado, competing against people around the world to essentially get health care for free. I mean their government around the world will pick up the bill. It's almost like our businesses are spotting the foreign competition 17-18 points on the very first day. We can't sustain that.
ROVNER: Which led to his latest effort, the Healthy Americans Act. The bill would basically end the current system in which most Americans get health insurance from their employers. Wyden says that's happening anyway.
Sen. WYDEN: The employer-based system is melting like a popsicle on a summer sidewalk.
ROVNER: Instead, individuals would buy their own coverage, with financial help for those who can't afford it. Len Nichols of the New America Foundation helped Wyden craft the bill. He says it is unlikely to pass this year, but it's been an important catalyst for the current health reform debate.
Mr. LEN NICHOLS (Director, Health Policy Program, New America Foundation): The conversations that are going on are laying the foundation for the future, and that's really what it's designed to do.
ROVNER: Wyden, however, insists he wants Congress to act this year, not to wait until after the next election.
Sen. WYDEN: It just wouldn't feel right to me when I see people coming to those town hall meetings, people in their fifties say, I just hope my employer can hang on to coverage until I get Medicare. That's what energizes me. That's what makes me say it's not something that ought to wait any longer.
ROVNER: Julie Rovner, NPR News, Washington.
MONTAGNE: And details of Senator Wyden's proposed Healthy Americans Act are at npr.org.
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