Health Care's Many Costs

February 09, 1992

Viewed in its best light, President Bush's belated entry into the health care debate offers assurance that the nation within the next few years will finally do something about this over-arching problem. By acknowledging that the present system is in "crisis" and by asserting society's obligation to provide health care to its most disadvantaged citizens, Mr. Bush has given what the American Medical Association calls an "aura of inevitability" to what we have termed "the issue of the decade."

There are many flaws in the president's plan, most especially his refusal to provide a convincing framework for controlling sky-rocketing costs or for financing an initiative bearing an official price tag of $100 billion over the next five years. There are equally serious flaws in the contradictory plans put forth by his Democratic rivals, most especially their over-reliance on government and their failure to address the astronomical costs of full or partial national health systems.

With an election year upon us, there is almost no chance Washington will act this year. Nevertheless, common ground exists in that the administration's plan and the Democratic leadership's "play or pay" scheme both place stress on pooling insurance funds so that small businesses can afford to buy insurance for workers now uncovered. Mr. Bush's laudatory comments about a private-sector pooling arrangement already in place in Cleveland might encourage Maryland business organizations to attempt similar initiatives.

After the election, politicians in both parties will have to confront the control and cost questions. It is lamentable that at the last minute the president dropped Budget Director Richard Darman's idea to make the health care premiums paid by employers taxable for those in higher income brackets. This would have made an important segment of the population more sensitive to the cost factor in health insurance -- now a perk that is pretty much taken for granted. It is also dismaying that critics of the president's plan quickly blasted away at his timid exploratory moves to put the brakes on out-of-control increases in the key health entitlement programs -- Medicare and Medicaid.

Until politicians muster the courage to finance and control the costs of health care, the American system will continue to devour more and more of the gross national product without delivering adequate medical services to all of its citizens. Under pressure from election-minded Republicans, Mr. Bush failed to come up with a plan that was bold and universal enough to win wide acceptance for an approach that rightly focuses on market forces and the private sector. But he and his party are at last real participants in a debate that millions of worried and vulnerable citizens insist must be at the top of the agenda in this decade.

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