Copyright 1999 The National Journal, Inc.
The National Journal
January 16, 1999
SECTION: HEALTH CARE; Pg. 113; Vol. 31, No. 3
LENGTH: 1397 words
HEADLINE:
Ducking Health Care Reform
BYLINE: Marilyn Werber
Serafini
BODY:
In the
1992 presidential campaign, health care reform was
an issue that no
candidate could afford to ignore. The ranks of
the uninsured had grown to 34
million, double-digit health care
inflation was squeezing the country, and
polls showed that the
cost and availability of health care was high on the
public's
list of concerns.
In the six years
since then, President Clinton and
Congress have tried once to approach the
nation's health care
problems in a comprehensive fashion. But the
spectacular failure
of that effort--Clinton's 1993 health care reform
plan--left both
sides hesitant to do anything more than tinker around the
edges
and hope that some of the problems highlighted in the 1992
campaign would be remedied by market forces now transforming the
health
care industry.
And why not take that approach? As
managed care began
sweeping through the health care industry, inflation
dropped to 3
or 4 percent in the mid-1990s. Employers who might have had to
stop offering health insurance to workers because of skyrocketing
prices
were able to continue coverage. That's the good news. The
bad news is that managed care
companies, as would companies in any budding
industry, held
prices at artificially low levels to remain competitive and
gain
market share. But stockholders' patience grew thin, and many
managed care executives decided last year that their companies
had to
bring in larger profits. So costs are on the rise again.
Premiums for 1999
are growing by 8 and 9 percent in some places,
and health care analysts
predict the rise will exceed 10 percent
before long. Moreover, the problem
of the uninsured has only been
getting worse. About 43 million people are
now uninsured, and
that number may climb to 53 million by 2007, according to
a study
released recently by the Health Insurance Association of America.
''There are some really substantial problems in
health
care, like the ones we've been threatening to deal with in the
last 30 years, on and off, like coverage issues, and re-emerging
cost
concerns,'' said Edward F. Howard, executive vice president
of the Alliance
for Health Reform, a nonpartisan Washington
organization that advocates
health care coverage for all
Americans. ''It's obviously something that's
not going away.''
When those problems will be
addressed is anybody's guess.
No one expects Congress to make any
large-scale, coherent attempt
to deal with the problems of the uninsured and
rising health care
costs in the next couple of years. The focus, for now, is
on
reviving a patients' bill of rights that died last year
and on
seeing if a bipartisan Medicare commission can make any headway
in figuring out how to extend the solvency of that program. Of
the two,
the patient's bill of rights, which addresses complaints
about managed care, is closer to enactment.
Here's a quick rundown on where things stand:
Managed care: Surveys
show that people credit managed care with
improving the nation's overall
health care system by emphasizing
preventive and coordinated care, and by
demanding efficiencies
that allow employers to continue offering health care
as a
benefit. Howard, for example, applauds managed care for its
systematic approach to studying which patient treatments really
work and
which do not. ''Managed care has gotten a bad rap on
quality, partially
because they're the only ones for which we've
been able to measure quality
at all,'' Howard said.
And Karen Ignagni, president
of the American Association
of Health Plans, which represents most managed
care plans, says
the recent cost increases are understandable. ''We've had
three
or four years of relatively flat or negative growth. It's not
unreasonable to expect that premiums should inch up. We're
developing
new drugs, new technologies, new therapies every day.
The question is, 'What
would the cost increases be in the absence
of managed care?' ''
Still,
the shift to managed care has not been entirely smooth.
Patients in managed
care frequently complain that they can't
always see the doctor of their
choice, take the prescription drug
that they want, or stay in the hospital
for as long as they
believe is necessary. Members of Congress and state
legislators
receive a constant stream of mail and phone calls from them.
Legislation that would give managed care patients
more
rights passed the House in 1998, but stalled in the Senate.
Public
demand for such legislation, though, is still strong, and
Congress is
expected to try again.
Prospects for action could be
boosted by the ascension of
Rep. J. Dennis Hastert, R-Ill., to the Speaker's
post. Hastert
has had a hand in every piece of major health care legislation
this decade. Indeed, last year's patients' bill of rights
legislation emerged from a House GOP task force that he chaired.
Hastert's original task force bill--not the one that passed the
House--was modest. With this in mind, health care analysts say
they
expect him to support a less radical bill than the last
House version, one
that more Democrats can support.
Medicare: The
health insurance program for older
Americans only has until 2008 before its
trust fund for hospital
insurance is estimated to go broke. A bipartisan
Medicare
commission is working now to find a way to extend its solvency--
perhaps until 2030.
The commission, headed by
Sen. John B. Breaux, D-La., and
Rep. William M. Thomas, R-Calif., is
supposed to report a series
of recommendations to Congress and the White
House by March 1 of
this year. The panel is looking closely at an approach
called
premium support that would make Medicare more like the widely
praised Federal Employee Health Benefit Plan, which is generous
with
benefits, but still cost-efficient. The idea is that
Medicare recipients
would get a set amount from the government to
help pay for a health
insurance plan of their choosing. The
government would probably establish a
core set of benefits that
each health plan would have to include, but plans
would also be
allowed to offer richer benefit packages. To purchase a health
plan with lots of extra benefits, a Medicare recipient would have
to pay
more out-of-pocket. Most members of the commission also
want to add a
prescription drug benefit to any basic benefits
package that is created.
But there's plenty of disagreement over other
reforms,
such as whether to increase Medicare's eligibility age from 65 to
67. Even if the commission produces consensus recommendations,
there's
no guarantee that Congress will act on them in 1999.
President Clinton and
congressional leaders have made Social
Security reform a top priority for
1999, and it's unlikely that
Congress would tackle two tough political
issues in the same
year.
Structural reform: Just
about everyone agrees that major
health care reform won't come before the
2000 presidential
campaign. And it may not even come after the 2000
election, if
health care reform doesn't emerge as a top campaign issue.
Until
then, reform ideas will remain largely the province of think
tanks
and a handful of concerned legislators.
One idea
that's getting significant attention is to
radically change--or even do away
with--the current system that
ties health insurance to jobs. It began as a
conservative
concept, but now many moderates are intrigued.
The current system started in World War II, when the
federal
government began giving tax breaks to employers who
offered their workers
health insurance. Many health care analysts
contend this is economically
inefficient because the consumer--
the worker--does not choose which health
plan to buy. Moreover,
self-employed individuals and small business
employees have
consistently been the ones left uninsured.
Thomas and others are working on plans that would shift
more
responsibilities to individuals, by giving tax breaks
directly to them, not
employers. That would be a huge change in
the health care system--one that
could generate every bit as much
controversy as Clinton's failed attempt to
reform the system in
1993.
LOAD-DATE: January 19,
1999 
