There for You

December 01, 1993|By MICHAEL TANNER

WASHINGTON — Washington.--Health care that's always there. Health care that can never be taken away. That is President Clinton's pitch for his health-care reform plan. It is also utter nonsense.

By turning health care into a political commodity, the Clinton plan ensures that health care can be taken away any time 51 percent of Congress decides to do so. Indeed, his plan sows the seeds of a system that can -- and will -- take away, not only the new health care he promises us, but the care we already have.

The process of taking away health care is well advanced in other countries with government-run health-care systems. In Canada, the process is known as ''delisting.'' Hundreds of procedures and medications that once were reimbursed by the government have been delisted. Recently, the Ontario government proposed giving itself power to dictate what services are medically necessary and how often patients can receive those services. Several other provinces may follow suit. And the national government announced last summer that it is considering charging ''user fees''' for some health services.

In Germany the 1989 Health Care Reform Act severely reduced the range of services included under the country's social insurance, while increasing the amount of a patient's co-payment for other services. Among the items no longer covered by the government are brand-name drugs. Now only generic products are reimbursed by the government. Recent budget-cutting proposals call for ''de-insuring''' still more services.

Britain, Spain and Sweden, are cutting back on the services and medicines that can be reimbursed under their national health-care systems. Some countries have raised the annual payment threshold (essentially a deductible) beyond which the government system kicks in. Nearly all have boosted co-payments and prescription fees.

In this country, the process has begun. Oregon's Medicaid program explicitly embraces the rationing of care. Under its new Medicaid reform, approved earlier this year by the Clinton administration, the state extended its Medicaid program to more recipients, but to control costs, the program now denies coverage for many previously reimbursed services.

The Oregon Health Services Commission drafted a priority list of 709 medical services, using a formula that considered cost, the duration of the treatment's benefit, and the amount of improvement in a patient's quality of life. The list was matched against the amount of funding available. In the program's first year, it is expected that Medicaid will pay for the first 585 services on the list. Thus, treatment for swelling of the esophagus (number 585) is covered. Disk surgery (number 586) is not.

The Clinton plan ''global budgeting'' makes the taking away of health care virtually inevitable. The government will set a limit on total health-care spending in the country, both public and private. What happens when spending reaches that limit? Will health care still always be there?

Indeed, President Clinton now says there will be a cap on the amount of funding available to subsidize health insurance for the poor. He's taking away benefits before the plan is even enacted.

That does not even take into account the more subtle denial of care that occurs when global budgeting and price controls make medical technology, services and medicines unavailable. In Canada the wait for a mammogram is two and a half months; for a pap smear, nearly five months; for hip replacement surgery, 18 months. Health care that's always there?

When individuals pay for their own health care, they decide what services to buy. When government pays for health care, it decides what services it will pay for. The availability of health services becomes subject to the whims of majority rule. Already, Congress is debating whether abortion services should be included in the national benefits package, how often mammograms should be paid for, and what types of mental-health benefits should be included. Whatever it decides to include today can be taken back tomorrow.

Nearly 30 years ago Barry Goldwater warned that ''a government big enough to give you everything you want is big enough to take away everything you have.'' Americans swayed by the promise of ''health care that can never be taken away'' should remember his words.

Michael Tanner is director of health and welfare studies at the Cato Institute.

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