GOVERNMENT & MEDICINE

System reform a top priority

The future of the nation's health care system involves a collective rolling up of sleeves and the development of a possibly uniquely American approach.

By Susan J. Landers, AMNews staff. Dec. 27, 1999.
AMNews Interim Meeting '99 coverage - AMA's Interim Meeting site.

San Diego -- Speakers representing a variety of political persuasions rallied behind a central premise at a forum on the future of the American health care system held during the AMA's Interim Meeting.

All favored discarding the system's current financing mechanism and starting over.

Rep. Jim McCrery (R, La.), a member of the House Ways and Means Committee, said he'd been working with Rep. Bill Thomas (R, Calif.) for 18 months on legislation that would sever the connection between health insurance and the workplace, enabling consumers to purchase their own insurance.

No bill has yet been introduced because the hurdles to such a radical shift are great, McCrery said. For example, he proposed that Medicaid be eliminated and low-income people be gathered into a new health care system. He also said he'd like to explore eliminating Medicare and bringing the elderly and disabled into the new system. But Thomas has not agreed to that.

Rep. Jim McDermott, MD (D, Wash.), said he stands behind the single-payer plan he proposed in 1993. That plan offers a package of defined benefits to everyone, with the government paying the bills.

Both representatives emphasized that physicians would play a central role in finding a solution to the nation's health care problems. "Without a doubt," said McCrery, "if we are to solve our problems in a way that is unique to this country, doctors are going to have to be very important players in finding that solution."

The recent House and Senate debates on HMO legislation, McCrery said, demonstrated the power physicians can wield over a congressional outcome.

Swelling ranks of uninsured a threat

But even greater than the health care problems posed by managed care, said McCrery, are the problems brought by the growing numbers of uninsured people -- now estimated at nearly 45 million.

What to do about the uninsured, McCrery said, is just one of the pressures driving policymakers to examine a government-controlled single-payer system that could turn out very much like the plan promoted by Dr. McDermott.

But McCrery said he would rather not mimic the single-payer plans that many other nations already have implemented. "I think our society has more guts than other societies and we should try something different," he said.

Included among the specific health insurance reforms being considered by McCrery are guaranteed coverage for all -- no denials for preexisting or medical conditions and a requirement that everyone purchase a basic health care policy. Tax credits would be available to enable low-income people to purchase insurance.

McCrery cautioned that implementing his proposal would mean many people would be worse off financially than they are under the current health insurance system. "But in my view," he said, "our society cannot afford to say to everybody, 'We are going to pay for all your health care.' " The result, he predicted, would be rationing of benefits.

Reform awaits next president

Dr. McDermott pointed out that President Clinton's health system reform proposal was defeated primarily over concerns that it allowed too much government control.

In the six years since then, he said, the health care system has been operating in a relatively unregulated environment; as a result "all the satisfaction of being a physician has gone." Patients are also unsatisfied with the current state of the nation's health care system, he said.

"It is clear," he said, "that allowing the market to drive the system has created a lot of problems."

Dr. McDermott said regardless of who is elected president, "[health care] is going to be right up on the table when we start in 2001." The question, he contended, is which direction to go.

Dr. McDermott said recent health system reform legislation, including the Health Insurance Portability and Accountability Act and the Children's Health Insurance Program, don't go far enough to affect needed change.

Also joining the House of Delegates' health care discussion were Katherine Swartz, PhD, associate professor at Harvard's School of Public Health; Greg Scandlen, publisher of the HBG Washington Weekly newsletter and Jeff Lemieux, director of economic studies at the Progressive Policy Institute.

Dr. Swartz conveyed a sense of urgency for the restructuring of health insurance markets, explaining that not only are the number of uninsured people increasing rapidly, but many more are low-income, less-skilled people leading the nation to a two-class society.

Scandlen, who also works at the libertarian Cato Institute, noted that employers are becoming tired of taking the responsibility for purchasing health insurance. "We are only one big regulation or economic downturn away from having the entire health care system collapse like a house of cards," he said.

Lemieux said patients were beginning to take control of the health care system; as an example, he cited patients arriving in physicians' offices armed with information from the Internet. Favoring this approach, Lemieux said he would like to go beyond a Patients' Bill of Rights and instead have a wholesale health care "transfer of deed" to the patient.

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