WASHINGTON — At the start of the new year, an old problem is forcing its way back onto the national agenda: health care. The American system of medicine is threatened with meltdown from a combination of rising costs, declining access and incredible inefficiencies. Throw in a batch of unresolved political differences and you have a mess that demands attention, even during a war on terrorism.
Shortly before the old year ended, I sat down with officials of the National Coalition on Health Care, a bipartisan organization whose honorary heads are former Presidents Ford, Carter and Bush and whose co-chairmen are two highly respected officials, Robert Ray, the former Republican governor of Iowa, and Paul Rogers, the former Democratic congressman from Florida. Its members include some 80 corporations, unions, health providers and consumer groups.
The picture that Dr. Henry Simmons, the coalition’s president, and Joel Miller, its research director, laid out for me is not a pretty one. Their phrase for it is borrowed from the best seller "The Perfect Storm": a confluence of forces, each worrisome in itself, but together posing a lethal threat.
The first is the rapid and accelerating rise in the cost of private health insurance. Premiums rose 8 percent in 2000, 11 percent last year and are expected to jump 15 percent this year. Even the biggest purchasers of group insurance cannot hold back the tide. CalPERS — the California Public Employees’ Retirement System — which for years was the national pacesetter in driving hard bargains with insurers, recognized its limitations and last year joined the coalition, seeking a national solution to the problem.
The second element is the squeeze on the two largest public programs, Medicare and Medicaid, resulting from the sudden shift from surpluses to deficits in the federal budget and in the states.
Third, the recession has hammered both large and small businesses, forcing them to trim or eliminate health benefits. The millions of Americans who became unemployed last year also lost their job-related health insurance. With unemployment likely to rise further this year even in optimistic economic scenarios, the problem will almost certainly worsen.
Fourth, as President Bush has acknowledged, the anthrax scare and threats of other forms of bioterrorism will require heavy new investments in the public health system, further straining financial resources.
Finally, finding a solution to all these problems is complicated by the strong differences between the parties on the right approach. The economic stimulus debate ended in deadlock and inaction last month, largely because Republicans and Democrats could not agree on how to provide temporary health insurance to laid-off workers.
A Kaiser Family Foundation survey early in 2001 noted that these partisan differences are rooted in fundamental disagreements between the constituencies of the two parties. For example, two-thirds of Democratic voters said Medicare should provide prescription drugs, but more Republican voters preferred that the government subsidize seniors’ purchase of private drug-benefit plans.
Robert Blendon of Harvard, who ran the study, said that bridging the gap on that and other health policy issues "will require an extraordinary level of give and take on both sides," something that is in short supply in Washington, even after the events of last Sept. 11.
The first need is simply to agree on the scale of the challenge. With a midterm election looming in 10 months, politicians in both parties are understandably eager to show they can "do something" about health care. But the easy fixes — for example, a compromise on a patients’ bill of rights to protect against abuses by managed-care companies — won’t do it. That measure, in fact, is likely to increase costs and could even aggravate the problem of wasteful expenditures for services of little or no health value by forcing HMO doctors to practice "defensive medicine" to ward off lawsuits.
What the coalition members understand is that as long as somewhere between 39 million and 44 million Americans are without health insurance of any kind, it will be impossible to solve the problems of cost and quality in the health care system.
It is also clear that tinkering around the edges cannot, for long, withstand the adverse trends that are at work, let alone reverse them.
This is an issue that cannot wait for the war on terrorism to end. It needs attention from the president and Congress. And it needs it now.
David Broder can be reached at The Washington Post Writers Group, 1150 15th St. NW, Washington, DC 20071-9200.
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