WASHINGTON -- As a first step toward assuring Americans access to long-term health care, the Clinton administration is considering making it available at first only to people belonging to group health organizations.
Ultimately, the administration wants all Americans to have guaranteed access to long-term care, but it will not be able to offer it to everyone immediately when it unveils its basic health benefits package. Vice President Al Gore made that clear yesterday during the first public meeting of the president's task force on health care reform.
He said: "We are determined that all health issues, including long-term care, will be addressed in health care reform."
Mr. Gore moderated the 12-hour meeting inside a George Washington University basketball arena in the absence of the task force leader, Hillary Rodham Clinton, who was in Little Rock with her gravely ill father. The marathon session included a sharp exchange between the vice president and a representative of the restaurant industry, who called mandated insurance "un-American."
Mr. Gore said that the administration's health reform legislation, due to be presented to Congress in little more than a month, would include "good mental health coverage" and a provision to stop "excessive profiteering" in the prescription drug industry.
Long-term care, which ranges from home and community-based services to nursing home stays, can be extremely costly. At present, only very poor people receive these services from the government, through Medicaid. Administration officials believe the benefit will have to be phased and limited in the beginning to people participating in cost-conscious, managed-care groups, like health maintenance organizations.
This approach would encourage senior citizens, who do not receive long-term care under Medicare, to join such groups. They would essentially give up their unrestricted use of doctors for access to long-term care.
The task force is still studying the length of a phase-in period. As a way of holding down costs, the administration is likely to limit the benefit to less expensive services at first, while adding nursing home coverage in later years. Mr. Gore underscored this yesterday, saying: "We want to emphasize home and community-based care."
The administration also would give states latitude if they want to establish their own long-term care programs, according to a source at an organization that is in regular contact with the task force.
The administration hasn't given up on the idea, however, of establishing long-term care as a social insurance program, like Social Security, for which all people pay and receive services, the source said.
Yesterday representatives of about 60 groups, among them physicians, insurers, consumer advocates, unions, employer organizations, hospitals and drug companies, gave the administration their views of how to fix the nation's health care system.
The testimony laid bare the fault lines in the health care reform debate: There were sharply expressed conflicts over what employers should be mandated to provide their employees, and the extent to which the government should impose cost controls on doctors, hospitals and insurers.
Mr. Gore argued with representatives of small businesses who said they'd be ruined if the government required them to insure workers. Citing data that 70 percent of small businesses provide insurance, he said health reform would help them by eliminating the cost advantage the other 30 percent have by not paying for insurance.
The most contentious exchange involved Mr. Gore and Stephen Elmont, vice president of the National Restaurant Association, who said that insurance mandates are "un-American" and that many younger people don't want insurance.
"I don't mean to offend," Mr. Gore said, "but I think most people want health insurance."
Task force member Donna E. Shalala, secretary of Health and Human Resources, noted that Social Security is mandated. And Mr. Gore, observing that restaurant health inspections are mandated, said: "The point I'm making is that some things applied universally make sense."
The vice president sought common ground with the small employers, whose support the administration wants for health reform. But Mr. Elmont resisted: "If I give an inch, I am terribly, terribly concerned about the cost of that inch. That's why I'm so paranoid."
When pressed to suggest how insurance coverage could be financed, some of the small business groups recommended that income taxes pay for it.
The largest group representing small businesses, the National Federation of Independent Business, refused an invitation to testify because the administration had already decided to require insurance of employers.
The administration's reform plan is based on expanding the current system of employer-provided insurance, and providing government subsidies to the poor and to low-wage workers at small firms.
Insuring the 35 million Americans who now lack coverage could cost $30 billion to $90 billion a year, and the administration is considering a variety of revenue sources, and timetables, for achieving this.
The administration also is planning to impose tough cost controls on the health, drug and insurance industries, including the possibility of price controls for a year or two. Mr. Gore emphasized that, saying "everyone who has been making money off of health care . . . will have to sacrifice."