Skip banner
HomeSourcesHow Do I?Site MapHelp
Return To Search FormFOCUS
Search Terms: "patients bill of rights"

Document ListExpanded ListKWICFULL format currently displayed

Previous Document Document 85 of 85.

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


     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

     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

LOAD-DATE: January 19, 1999

Previous Document Document 85 of 85.


Search Terms: "patients bill of rights"
To narrow your search, please enter a word or phrase:
About LEXIS-NEXIS® Academic Universe Terms and Conditions Top of Page
Copyright © 2001, LEXIS-NEXIS®, a division of Reed Elsevier Inc. All Rights Reserved.