Forum probes health-care reform plans

September 16, 1992|By Douglas Birch | Douglas Birch,Staff Writer

The ailment was the same. But the prescriptions differed sharply.

Health-policy advisers to both President Bush and Gov. Bill Clinton, appearing yesterday at the Johns Hopkins School of Public Health, were asked about "L.N.," a child who died June 18 of tuberculosis and meningitis, probably because he saw a succession of emergency-room doctors at an unidentified hospital rather than a personal physician who knew his case. L.N.'s father was working, but couldn't afford health insurance.

How would the candidates make sure that others among the 33 million Americans without health coverage don't suffer L.N.'s fate? And how could they make sure that health-care coverage remains within the reach of everyone else? The questions were asked by physicians and others at a forum called "Access to Health Care."

Gail R. Wilensky, the president's deputy assistant for policy development and former head of the Health Care Financing Administration, said families like L.N.'s would be guaranteed access to care through President Bush's proposal to give transferable tax credits to low-income families to purchase private health coverage.

Costs could be reined in for the rest of Americans, she said, if they are given the information they need to shop for low-cost, quality care.

Judith Feder, co-director of Georgetown University's Center for Health Policy Studies and one of Mr. Clinton's health-care jTC advisers, said that only the Democratic candidate's plan would guarantee affordable health coverage for everyone.

Mr. Clinton and Democratic leaders have proposed requiring all employers to buy health insurance for their workers or pay a tax to finance a public health plan in which their employees could enroll.

The candidate also favors establishing a national health budget that would set overall limits on health spending by both the public and private sector.

The Democratic proposal is similar to one made Monday by the 77,000-member American College of Physicians, which endorsed implementing the national health budget by having the states set spending caps on the fees that doctors and hospitals charge public insurers.

Ms. Feder said the president's plan didn't go far enough. It

would, she said, require a family of three, with an income of $17,000 annually, to pay 15 percent to 20 percent of its income for health coverage, not counting other costs.

It would not, she said, encourage small businesses that do not now offer health plans to do so.

"To argue that that gives affordable coverage to everyone is to stretch the imagination," she said.

Ms. Wilensky said the proposal supported by Mr. Clinton and the college of physicians would jeopardize precious low-wage jobs, hurting the people the plan was intended to protect. She said employers may cut marginal jobs rather than contribute to a private or public health plan.

President Bush has denounced proposals for a national health budget, saying it will lead to the stringent rationing of health care.

"We want to make sure that the coverage is available and rules are followed," said Ms. Wilensky, the former administrator of the nation's Medicaid and Medicare programs. "But we want to guarantee choice within that framework."

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