Mitchell health care plan assailed as too costly

August 11, 1994|By John Fairhall and Karen Hosler | John Fairhall and Karen Hosler,Washington Bureau of The Sun

WASHINGTON -- Opponents opened a new line of attack yesterday against the Senate version of President Clinton's health care reform proposal, branding it a bureaucratic nightmare that fails to curb skyrocketing medical expenses.

The predominantly Republican assault on the second day of debate on the Democratic bill barely mentioned its most controversial provision: that employers may ultimately be asked

to pay 50 percent of the cost of health care for their workers.

That provision would take effect if voluntary measures and government subsidies didn't achieve 95 percent coverage of Americans by 2000.

Instead, critics brandished a new analysis from the nonpartisan Congressional Budget Office to argue that the 1,400-page bill hastily crafted by Senate Majority Leader George J. Mitchell of Maine is unworkable.

"This bill does nothing to slow the rate of overall health care costs in this country," declared Sen. Pete V. Domenici of New Mexico, the ranking Republican on the Senate Budget Committee.

"Even after all this rigmarole . . . spending will go up by $240 billion to $285 billion over the next decade."

America's health care bill is nearing $1 trillion this year, and rising costs are the main reason that 39 million Americans have no insurance. But the budget office gave a failing grade to Mr. Mitchell's key cost-control device -- a 25 percent tax on premiums of health insurance plans whose prices rise faster than a government-calculated standard.

The CBO said this would have only "limited" effect on containing costs and actually could backfire. Insurance plans hit by this tax would raise premiums, which, in turn, could discourage some people from buying insurance.

Many economists agree with the budget office. "Cost controls are not even in the periphery in the Mitchell bill," said Uwe Reinhardt, a Princeton University health economist.

Sen. Bob Kerrey of Nebraska was the first Democrat to criticize the Mitchell plan on the Senate floor. He said costs of subsidies and new programs, such as prescription-drug benefits for the elderly and long-term care for the disabled, are underestimated.

"We've got to be honest and say that this stuff gets expensive," Mr. Kerrey said.

Other senators focused on a CBO finding that Mr. Mitchell's proposed targeted subsidies to high-risk groups, such as pregnant women, would be a bureaucratic headache for the states.

Sen. Nancy L. Kassebaum, a Kansas Republican, charged that the regulatory process is so "Byzantine" and invasive that women would have to provide updates on their reproductive status, including miscarriages and abortions.

"What might sound complicated at this point would only grow even more complex as we move into implementation," she said.

But President Clinton urged lawmakers yesterday to put aside their "almost hysterical fear" of supporting the Democratic health care proposals pending in both houses.

"There was just this kill it, kill it, kill it, kill it, kill it drumbeat coming out of the ones who were negative," Mr. Clinton said, referring to the yearlong campaign by business and health industry lobbyists.

After the first 10 hours of Senate debate on the most complex and explosive social undertaking Congress has tackled for at least three decades, it's not clear how the public attitude has reacted.

Robert J. Blendon, a Harvard professor who is an expert on public opinion on health reform, said that "it will take a while before it looks like people are responding to the debate."

"Though interesting, I think it's hard for people to identify with, because they principally want to know how it's going to affect them personally, and the debate is not that clear about that," Mr. Blendon said.

Senate backers of the Mitchell bill have devoted themselves largely to emotional appeals, laced with tragic stories of individuals denied health insurance.

By contrast, the Republicans have kept their rhetoric cool and their arguments focused on the cost and big-government issues.

Generally, the cost issue has overshadowed the reform debate. Fast-rising health costs would undermine the federal insurance subsidy program for the poor -- the centerpiece of the Mitchell plan for increasing coverage of Americans -- by making it prohibitively expensive.

But in drafting cost-control provisions, Mr. Mitchell eliminated the most controversial proposals in Mr. Clinton's original legislation: government-imposed budgets for health care spending and controls on insurance premium increases.

Congressional critics attacked the Clinton proposals as government overkill. But those same Senate critics generally won't endorse any other politically painful proposals, such as a tax on expensive employee health plans, which would encourage consumers to buy cheaper coverage from health maintenance organizations.

PTC "This is one of the great ironies of this debate," Hillary Rodham Clinton observed Tuesday. "The very people who say health care costs too much are the very people who don't want cost control in health reform."

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