Copyright 2000 / Los Angeles Times
Los Angeles
Times
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October 8, 2000, Sunday, Home Edition
SECTION: Opinion; Part M; Page 4; Editorial Writers
Desk
LENGTH: 1085 words
HEADLINE: ELECTION 2000 / PRESIDENTIAL RACE;
HEALTH CARE: BE AMBITIOUS
BODY:
Health care
reform--or more accurately, the debate about small parts of health care
reform--was a key theme in last week's presidential debates. Unfortunately, both
Al Gore and George W. Bush--rather than taking the risk of trying to explain the
trade-offs inherent in any health care reform or of suggesting solutions to core
health care problems--have been playing it safe, articulating what they think
voters want to hear and advocating policies designed to appeal to core
constituencies.
Both candidates have spent most of their time
championing reforms that are insubstantial when compared with their own party's
previous proposals--or even with current proposals now being seriously debated
off the campaign trail by health care experts in both the Republican and
Democratic parties.
For example, Bush's proposal to give a $ 2,000
tax credit for health
insurance to families with annual incomes below $ 30,000 falls far
short of covering the average family policy, which costs more than $ 6,000.
Similar in its lack of reach is Gore's proposal to expand the existing federal
Children's Health Insurance Program over the next five years to cover all
children in working-poor families with incomes below 250% of the federal poverty
level. That's no more generous than what many states have already agreed to
offer. Moreover, the children who are the focus of both candidates' health
reforms are generally the least costly Americans to insure; young and relatively
healthy, they are what health economists coolly refer to as "the low-lying
fruit."
That said, the two candidates have taken distinct positions on
how to guarantee basic health benefits and to control health care costs, which
are soaring at more than three times the general rate of inflation.
In
the long term, Gore's plan to add a prescription drug benefit and otherwise
reform Medicare could prove fiscally wiser than Bush's Medicare reform plan.
While Gore would boost overall Medicare spending by $ 356 billion over 10 years,
more than twice the boost proposed by his GOP rival, Bush would funnel the new
Medicare dollars to private insurers, an idea that has led to major
cost-inefficiencies in the "Medigap" add-on insurance programs now offered by
private insurers. Medigap plans have been models of waste, with high
administrative costs and great instability wherein insurers enter and leave the
market and change benefits from year to year.
The structural problems
that Bush sees in Medicare would hardly be solved by his key reform: letting
HMOs and other private insurers draw up benefits packages that are in their best
economic interests rather than in the patient's best interest.
Gore, by
contrast, would have regional government buyers competitively bid for a basic
package of essential health care services--cost-effective drugs and other
well-proven medical treatments. That would use the government's market clout to
drive down costs, much as other developed nations do now.
Gore's plan
also addresses another growing problem that Bush slights: the likely increase in
the number of uninsured Americans as the baby boomers either voluntarily retire
or are forced into retirement before age 65, the Medicare qualification age.
Gore would provide a $ 3,000 tax credit to compensate for home care, adult day
care and respite services, and he would allow people between 55 and 65 to buy
into Medicare. Gore's plan could usefully protect aging baby boomers from losing
health insurance when they retire or "get retired," but the Democratic candidate
has to show voters that he could structure the new benefit in a way that would
not sap the Medicare trust fund.
Most health care policy experts believe
that Congress won't consider fundamental change until cataclysmic problems put
the health care system on the verge of collapse. However, some experts say that
an implosion of the system might be closer than many Americans think. They point
to problems like the growing precariousness of emergency health care hospitals
in big cities like Los Angeles, despite the booming economy, and to the fact
that an economic downturn could easily send the uninsured rate skyrocketing.
The problems have grown so dire that even once-staunch defenders of the
present health care system like House Majority Leader Dick Armey (R-Texas) now
believe that fundamental reform is essential. As Armey puts it, the growing
number of uninsured and underinsured Americans "is clearly a structural problem
we ignore at our peril."
The best example of this new, emerging
consensus on the need for structural change comes from a plan devised by two key
members of the House Ways and Means Committee, Reps. Jim McCrery (R-La.) and Jim
McDermott (D-Wash.), and presented in an interview published in this month's
edition of the Atlantic Monthly.
The plan would define a basic package
of essential medical benefits that all health insurers should cover, overhaul
the current system of employer-based tax subsidies that provides most Americans
with health insurance, guarantee universal coverage, offer ample subsidies for
those who need them and require "community-rated" insurance policies under which
everyone pays the same premium, regardless of age, sex or medical history.
McDermott said reform is complicated by "the human emotional problem of
'I have this now; if I let go of it, why should I trust a politician?' " Indeed,
Americans' skepticism about politicians' big promises is not without reason,
given that Congress has burned Americans in the past by breaking repeated
promises to fix core health care problems.
Nevertheless, both liberal
and conservative health care policy experts agree that fundamental health care
reforms of the kind that McCrery and McDermott suggest will be necessary to
bring equity and cost-efficiency to the U.S. health care system.
Bush
has the right rhetoric to get the job done: In the debate he promised to seek a
bipartisan consensus on health reform that as he correctly pointed out has so
far eluded Gore. But Bush has the wrong solutions. His idea of giving private
health providers more power to determine benefits is medically chancy, and his
notion of letting all seniors buy into the wildly expensive federal health
benefits program could make Medicare go bust.
Gore's health reform plan
has more ambition, more essential consumer protections and more tools to promote
the sort of cost savings that will be necessary to keep the U.S. health care
system solvent.
LOAD-DATE: October 9, 2000
