The outlook for health care reform

January 16, 1992

For many Americans -- especially the 37 million who have no health insurance coverage -- the crisis in health care is old news. But the wake-up call for politicians didn't get through until November, with Sen. Harris Wofford's stunning upset of former Attorney General Dick Thornburgh in Pennsylvania's Senate race. Now the pressure is on politicians at all levels.

Congressional Democrats this week held town meetings around the country on health care, and President Bush promises to outline his plans in his State of the Union speech or soon thereafter. This issue will loom large in the coming campaigns.

But that doesn't mean voters can count on quick solutions, or even good ones. The health care morass is so complicated -- and the $700 billion-a-year industry has become such a large part of the national economy -- there is a real danger of partisan political debate producing too much heat and too little light.

The best chance for finding workable solutions could come from reform efforts in various states. That lends urgency to Maryland's own attempts to improve its health care system. Last weekend, Governor Schaefer assembled a "health care summit" to examine the state's problems and to explore grounds for consensus among advocates of various reforms. Conceivably, this session of the General Assembly could see passage of reforms that would serve as a model for the rest of the nation.

Despite its problems -- for instance, 570,000 Marylanders have no health insurance -- the state is well suited to undertake a demonstration project. Maryland has already proven it can keep hospital costs below the national average through an institutional cost-review system. It has also undertaken malpractice insurance reform and, as of last year, made possible a basic benefits package for small businesses. These steps help to put Maryland well ahead of many other states and may even set the stage for the kind of creative reform that could truly provide a national model.

Most reform proposals fit one of three categories:

* A single-payer system, similar to Canada's, would have the government take over payment of health-care bills while allowing patients to choose their own providers. This system would require higher taxes, but would eliminate many other costs that now inflate the system.

* "Pay or play" plans require employers to choose between providing basic health care benefits or paying into a special fund that would make coverage available to those who need it.

* A third category focuses less on government's role and more on tax incentives and market-based reforms. So far, this category has attracted the least public attention, but it may well produce some of the most promising combinations of ideas.

Confused? You're not alone. But complicated problems aren't solved by easy solutions, and politicians will serve no one by embracing a quick fix to America's health-care problems.

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