Health care dilemma: Where lies the blame? Difference of perception may trip reform

April 12, 1993|By John Fairhall | John Fairhall,Staff Writer

Sylvester Givens doesn't need a medical degree to diagnose what's wrong with the health care system: Greedy doctors, says the 49-year-old Marriott Corp. worker.

"I think they should be paid less," he says, while waiting for his daughter to see a physician at a pediatric clinic in Columbia. "When you see a doctor with almost a $1,000 suit on, you know money is this doctor's practice."

Many Americans share his complaint. They believe that profiteering in the health and insurance industries is driving the soaring cost of medical care, making it increasingly unaffordable and jeopardizing their sense of security. For the majority of the public, health reform mostly means clamping down on high prices.

But the popular perception of what's wrong clashes with the views of experts advising the president's task force on health care reform. These policy consultants and academics don't believe greed is as much of a problem as excessive consumer use of medical services, particularly expensive specialists and costly high-tech equipment and procedures.

And the experts' prescription for long-term reform is a lot different from most Americans': Push people into cost-conscious groups like health maintenance organizations, where they'd surrender some of their cherished freedom to choose doctors, and lose some access to expensive new technology.

This gulf of understanding between citizens and experts could portend disaster for the administration, which plans to unveil a proposal next month for accomplishing two major goals: controlling health care costs and guaranteeing health insurance for all Americans. The plan is expected to go far beyond the reforms approved last week by the Maryland General Assembly. If President Clinton's proposal conflicts with public expectations, or calls for unwanted sacrifice, reform might be scuttled by the people it is supposed to help.

Anxious to avoid this, Mr. Clinton and Hillary Rodham Clinton, the task force leader, are charting health reform in consultation with public opinion analysts and political advisers like the presidential campaign pollster Stanley Greenberg.

The Clintons are shrewdly acknowledging public concern about alleged overcharging, even though health care experts don't think it's a big issue. They have denounced drug companies for "shocking" price increases and accused insurers of profiting at the expense of people with serious illnesses. Most likely, the administration will respond to the public's demand for action by imposing tough short-term cost controls, perhaps even a price freeze on doctors, hospitals, insurance firms and drug manufacturers.

At every opportunity, the first couple hammers away at what surveys show is the major issue propelling reform: fear of losing affordable health care. For a guarantee of security -- a basic package of health insurance regardless of risk or change in employment -- most Americans say they are willing to accept modest trade-offs, such as slightly higher taxes, and perhaps even some limits on choosing doctors and hospitals, a number of surveys reveal.

But Americans can be pushed only so far on health reform, these surveys show. For all their anxiety, four of five people still have at least some health insurance, largely paid for by private employers or the government. And most say the care they receive is good.

'Don't send me the bill'

These attitudes represent a great red flag against overzealous reform. Americans want the system repaired, not replaced. When the Clinton administration presents its plan this spring, the average person is likely to judge it in personal terms: Does it give me better benefits? Does it cost more than I'm paying now?

"I think there are two messages from the public," says Bill Gradison, a former Republican congressman from Ohio who specialized in health issues and now heads an association of insurance companies. "First, the American public will consume as much health care as someone else is willing to pay for. And second, with regard to health reform, the public is for it, but what they are saying is, 'Fix it, but don't send me the bill.' "

This spells trouble for the administration as it tries to finance insurance for 35 million Americans who lack it. Even though the public wholeheartedly agrees with the president that everyone should have coverage, taxpayers don't want to shoulder the whole price -- up to $90 billion a year.

Thomas Stripling, 39, a federal worker from Olney, is willing to pay something, but not a lot. "I would have to see how much it would require out of my paycheck," he says.

Ed Perkins, who lives in Lanham, says the government should improve management of the health care system before asking for more taxes. "I believe if they could control the cost of this stuff, they've got enough money right now."

Alleged price-gouging by doctors, drug companies, hospitals and insurers tops most consumers' lists of what needs to be controlled.

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