When Pennsylvania's Harris Wofford won an upset victory over Attorney General Richard Thornburgh to retain his Senate seat last fall, his relentless emphasis on health care got much of the credit.
Politicians across the country -- including President Bush -- began to pay more attention to the issue. It looked as if health care reform had finally made it onto the political agenda in a big way.
With the presidential campaign in full swing, access to health care is still a big concern with voters. For politicians, it's more of a headache. Few issues present so many complications. For politicians -- or anyone else -- getting a handle on the various factors that have created the current crisis is a little like trying to grab hold of a slippery eel.
The candidates often talk about the large philosophical differences that distinguish various approaches, especially differences over government's role in health care. But these disagreements may not be any more difficult than less obvious obstacles to change.
The NIMBY factor -- "Not In My Back Yard" -- has become a familiar problem to officials seeking to place facilities ranging from sewage treatment plants to halfway houses in neighborhoods where residents regard them as unwelcome intrusions. The same tendency is complicating the health care crisis, particularly as reform efforts step on the toes of entrenched interests.
While everyone in this country agrees that health care reform should be a priority, almost everyone involved in the system believes equally strongly that reform should begin somewhere else.
That tendency is abundantly evident here in Maryland. In the first six months of this year, health-related groups paid out $1.3 million to lobbyists in Annapolis to represent their various causes; the largest single fee paid to any lobbyist, $99,000, went to Gerard E. Evans for representing the state medical society.
From brain surgeons and podiatrists to pharmacists and dental hygienists, hardly any medical specialty or related profession dares to go without representation.
This is not confined to organizations of medical professionals. Health-related businesses, from nursing homes to hearing aid specialists, also help support the state's flourishing lobbying industry. Inevitably, the hefty fees lobbyists receive add to the cost of health care -- and, more often than not, represent an investment in the status quo.
Why all the lobbying activity? Like every other industry, health care is filled with practitioners and business people who guard their turf -- and their incomes. They need lobbyists to protect them from legislation that could cost them money or market share.
Apart from regulatory tussles, the NIMBY factor crops up in other ways as well. A good example is the way proprietary interests restrict the use of medical data to improve medical practice throughout the country.
To cite one example, four times more hysterectomies are performed on the West Coast than in East Coast medical centers. Why the difference? Are West Coast women getting better treatment? Are West Coast physicians performing too many hysterectomies, or the East Coast too few?
Theoretically, the data exists to answer questions about the wide discrepancies in the rates of various medical procedures. But currently there is no way to pull together the information in ways that could lead to better-informed decisions about medical care. Moreover, there are no incentives for health insurers, doctors, hospitals or other treatment facilities to share their information on treatments and outcomes.
Complicating the provincial attitude toward medical data are legitimate concerns about privacy. But if all those who held various pieces of this data could be persuaded that the information would be put to good use, privacy concerns could be adequately addressed.
Senator Wofford was lucky. By being the first to capitalize on health care in a highly visible campaign he could cash in on the crisis largely by drawing attention to it. When it came to details, his pronouncements got a bit fuzzy.
President Bush and Governor Clinton are being pressed for specifics. That's why neither one is getting the bounce from health care the Wofford campaign received.
Finding solutions to the health care crisis will not be an easy process -- in large part because it will require giving up the American addiction to turf and to the assumption that a pervasive crisis can be resolved if only everyone else makes changes.
In this case, change begins at home, and that's not a popular message.
Sara Engram is editorial-page director of The Evening Sun.