3 candidates far apart on cure for ailing health-care system

October 15, 1992|By Gilbert A. Lewthwaite | Gilbert A. Lewthwaite,Washington Bureau

WASHINGTON -- If there is one issue, beyond the economy that dramatizes the different philosophies of the presidential candidates, it is health care. All they can agree on is that something must be done.

President Bush sees the solution in improving the private market. Gov. Bill Clinton advocates a more activist government role. Independent candidate Ross Perot looks to "the people" for the answer.

For a country that spends twice as much on health care as on defense or education, there is a shocking degree of dissatisfaction with what the money currently buys.

There are two reasons for this: ever-escalating costs and increasingly restricted access.

It's a crisis that has been in the making for years, but not until a special Senate election in Pennsylvania ended in an upset a year ago did health care reform become a political imperative.

In that race, little-known Democratic Sen. Harris Wofford, running as a single-minded health-care reformer, defeated the high-profile Republican former U.S. attorney general, Richard L. Thornburgh. In the process, Mr. Wofford defined an issue whose time had come for this presidential election year.

The United States devotes a higher percentage of its gross domestic product to the well-being of body and mind than any other nation. Yet, in the richest society on earth, an estimated 35 million Americans are still without health coverage, 600,000 of them in Maryland. Even those who are covered can still be bankrupted by medical bills.

That, to millions of voters and to all three of this year's presidential candidates, has finally become unacceptable.

So dramatic has been the increase in health-care costs -- just under 10 percent a year for the past five years, almost triple the general inflation rate -- that it has now become almost as much an economic as a social issue.

And with 80 million maturing post-World War II baby-boomers likely to need ever more care and attention as they grow older, the situation threatens to get worse before it gets better.

Without reform, health spending will increase from $888.7 billion in 1993 to $1.61 trillion in 2000, according to the Health Care Financing Authority

Alarmed by the trend, the Bush administration's budget director, Richard G. Darman, warned in the fiscal 1993 budget:

"Total U.S. public and private spending on health is literally on an unsustainable path -- threatening to consume an impossible proportion of gross domestic product [the nation's total output of goods and services]."

The Congressional Budget Office (CBO) estimates that spending on health care will consume 18 percent of the gross national product by 2000. This will be a 50 percent higher proportion than in 1990.

As costs rise, so do insurance premiums, putting both companies and individuals under financial strain, and swelling the ranks of the uninsured. The CBO expects 40 million Americans to be uninsured in 2000 if the system is not changed.

The impact is also felt by governments, national and local.

The health-care entitlement programs -- Medicare for the elderly and Medicaid for the needy and disabled -- are the fastest-growing segments of the budget. In 1970 they accounted for only 5 percent of federal outlays. By 1990 they were consuming 12 percent, and the CBO projects that by 2002 they will be gorging 25 percent if the present system is not changed.

Health-related spending by state governments across the nation expected to more than double from $100 billion in 1991 to $244 billion by the year 2000. The main state cost is helping finance the Medicaid program, providing funds for hospitals, clinics and other public health services.

Since almost all states, including Maryland, have balanced budget requirements, the extra outlays will have to be funded by tax increases or spending cuts.

"Thus, rising Medicaid costs are likely to crowd out other state priorities, such as rebuilding infrastructure, funding grants to local governments for education, or providing tax relief," warns the CBO in a newly published report.

Into this morass have stepped the presidential candidates, each brandishing his own reform program.

Mr. Perot's is little more than a vague clarion call for "the finest, most modern, and most comprehensive health care in the world." He wants a system based on a public-private partnership, and encourages "everyone involved" to reach "a consensus" on the principles of universal coverage and cost containment.

In one of his few detailed comments on health care, Mr. Perot, in his best-seller paperback "United We Stand, How We Can Take Back Our Country," advocates prevention, saying: "One dollar spent on prenatal care saves more than three dollars of special care for the newborn. One dollar of inexpensive immunizations saves $10 of health care and other costs."

Mr. Bush and Mr. Clinton have produced reform packages designed to restrain costs and broaden access.

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