The government's role in providing health care Our Turn

October 24, 1991

Republicans and Democrats cannot agree on a federal plan to provide all Americans with basic health care. What role should the federal government play in dealing with the nation's health

care crisis?

BONNIE ERBE: The patient is on the respirator and its pulse is dropping precipitously. The patient is the nation's health care system, which suffers from a terminal case of dissipation and inefficiency.

American health care technology is among the most advanced in the world. But it's available only to those who can pay. Some 60 million Americans have inadequate medical coverage or none at all. There are more MRIs (Magnetic Resonant Imaging machines) in San Francisco than in all of Canada, but thousands of women see a doctor for the first time during pregnancy upon arrival at the emergency room to give birth. The contrast between care for those who can pay and those who can't is staggering.

In programs where the federal government has tried to fill the health care gap (Medicare or Medicaid), cost controls are virtually non-existent, and expenses are soaring.

How, then, do pioneering states provide their citizens with quality health care? Hawaii covers health care costs for 98 percent of its residents. Employers must absorb part of the health insurance premiums for those who work at least 20 hours per week. Employees pick up the rest.

Those Hawaiians who are unemployed pay a small fee for each doctor's visit, and Medicaid pays the balance. The emphasis is on preventive medicine, so major medical calamities may be avoided because patients see doctors for regular check-ups. And the average Hawaiian, as a result, is in better health and lives longer than the rest of his or her compatriots.

The federal government could address the health care crisis, but political gridlock has stalled Congress and the White House isn't even trying. The Bush administration refuses to propose any health care plan at all. There are so many competing Democratic plans in Congress that none is on a fast track to passage.

At this rate, the patient will remain on the respirator indefinitely, and the prognosis is: Chances for recovery are slim to none.


KATE O'BEIRNE: America's health care financing system might on the critical list, but my colleague's prescription for recovery will send it into full cardiac arrest. There is broad consensus for a national health system that assures all citizens affordable health care -- but that doesn't mean there's consensus for a government-run national health program. Imagine trusting the same people who sometimes deliver your mail on time with health care delivery!

Some politicians advocate a government-funded program like they have in Britain, Sweden and Canada. In theory, all citizens have virtually free access to hospitals and physicians, and the government picks up the tab. In fact, such socialized programs result in long waits, high costs and less of everything else: doctors, equipment, operating rooms and hospital beds.

While most Americans are wary of a national health service, many, like my colleague, are drawn to the idea of requiring employers to provide "free" health insurance to workers and their families. In the short term, forcing employers to spend even more health care would lead to layoffs, wage freezes, job discrimination and more health cost inflation. In the long term, widespread dissatisfaction would lead to adoption of a government-run program -- which is what liberal lawmakers really want.

Policymakers could ensure that all Americans have adequate medical care simply by changing the tax treatment of health benefits. Currently, about 80 percent of working Americans and their dependents are covered by employer-provided, tax-free insurance. Workers and their families should be given direct control over the money used to purchase medical care and insurance, financed with a tax credit.

The current system of employer-provided insurance creates the illusion that health care is "free," and employees lack the incentive to shop around for the most cost-efficient care. Increasingly, workers worry about changing jobs and losing coverage altogether.

Only when families can shop around for the best deal in health insurance, with the assistance of a tax credit, will market forces begin to control costs. Let's hope that such a consumer-driven reform is adopted before liberal lawmakers commit medical malpractice by prescribing socialism for what ails us.

Bonnie Erbe is legal affairs correspondent for the Mutual/NBC Radio Network. Kate O'Beirne is vice president of government relations at the Heritage Foundation.

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