Health Care Heats Up

November 17, 1991

The nation's $670 billion-a-year health care system has suddenly become a political issue that President Bush can no longer ignore. First there was Democratic Sen. Harris Wofford's upset victory in Pennsylvania through a campaign in which 50 percent of his voters were influenced by his call for wide-ranging reforms. Now important elements of big business have teamed up with organized labor behind a "play-or-pay" plan that would extend health care insurance to the estimated 35 million Americans not covered.

On the morning after Senator Wofford's triumph, a jolted president said he had gotten "the message" and two days after that, he declared: "I'd like to have a comprehensive health care plan that I can vigorously take to the American people." This statement marked a turnabout for Mr. Bush, who has avoided concrete proposals to deal with a system plagued by runaway costs, gross inequities and poor or non-existent delivery of services.

While most people caught up in the very complicated health-care debate agree the system is sick and needs attention, there are huge differences about what should be done about it.

The latest plan, closely tracking some Democratic proposals, was put forward by a group called the National Leadership Coalition for Health Care Reform. It includes such Baltimore-oriented companies as Westinghouse and Bethlehem Steel. Employers would provide their workers with health insurance or would be hit by a 7 percent payroll tax (matched by a 1.75 percent employee tax) to help the government provide insurance. Small businesses predictably object, arguing added labor costs will make it impossible for them to compete.

Equally incendiary is the coalition's call for a federal board with broad powers to set limits on doctors' and hospital fees and other costs in health care delivery. The health-care industry will resist such government intrusion.

This newspaper has long favored broader health insurance coverage for two reasons: First, it would provide medical care to millions of Americans who now lack coverage and are forced to rely on Medicaid -- or nothing. Second, it would place the burden on all employers, thus preventing some from getting a free ride that eventually has to be paid by society as a whole. To make the transition easier, tax incentives could be offered to small businesses which, in turn, could look forward to more effective government cost-control efforts.

Chances are health care will be more a subject for partisan debate than for legislative action until the 1992 election has ended. If that is the case, the country would be well-served if the debate leads to concrete results in 1993. The issue needs airing.

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