Loss and Gain on Health Care

August 30, 1994|By GARRY WILLS

Chicago -- Health care, we are told, is dead for now -- moribund as Congress flees Washington and begins bracing for the November elections. But dead bills can sometimes linger out a half-recognized afterlife.

The best recent example is the Women's Equal Rights Amendment. That failed to pass, after long and brilliant opposition from anti-feminists such as Phyllis Schlafly. There was deep and justified disappointment on the part of some women when the effort failed. But other feminists, almost sheepishly, admitted that many of the goals pursued by the amendment had in fact been achieved. The mere effort to promote the amendment, the focusing of attention, made courts, employers, faculties, bar committees alter their policies.

Some did this to block the amendment, saying it was unnecessary. Others did it because they had not seen the inequities inflicted on women until the ERA debate made them visible. Many of these changes would no doubt have come in time, but the pressure of the ERA campaign made them happen earlier, which moved up history's timetable and broadened the front of possible change.

It appears that a similar process has begun in the area of health care. The federal plan suggested by the Clinton administration may not be perfect; but it focused attention on current inequalities in health coverage, health costs and health profits. Medical businesses and insurers have been cleaning up their act, in part to show that they can handle the problem without help from the federal government.

There has been a boom in health-maintenance organizations (HMOs), a drop in drug costs, a slowing of the increases in doctors' fees. Buyers of health care are getting more sophisticated and demanding, informed by the debate over the federal plan.

The Wall Street Journal reports a Stanford study showing a 10 percent increase in HMOs over the last year -- a trend that could almost double their use by the year 2000.

These HMOs cut costs by streamlining care -- providing fewer options but increased efficiency. This was the aim of the federal program, criticized for the reduction of options. Defenders of ''market solutions'' do not mind when the limits are the buyer's own choice.

On the cost front, to quote the Journal: ''During the 12 months ended July 31, medical prices in the Consumer Price Index rose 4.6 percent. If that rate remains steady through all of 1994, it will mark the smallest rise in medical prices in more than two decades.''

Bids coming in from insurers are sinking drastically for those corporations with their own health plans. Hewlett-Packard is receiving bids with cuts from last year that amount to 15 percent in some cases.

The Eli Lilly drug firm reports an average drop of 2 percent in its sales prices, a matter it hopes to make up in larger sales to organized medical plans. Some of this may be temporary, to take off the pressure for federal action. But it is motion in the right direction.

Celebrants of the free market can point to these developments, still only marginal, to show that the private sector can handle health. But it was not doing very well until the threat of federal action made reforms begin. In that sense, the government's ''interference'' with the market has already had some good effect.

Most of these reforms work for better delivery or lower costs among those already insured or in the most insurable parts of the population. The omitted, the poor, the unorganized continue to receive care on a spotty basis, with poor prevention and no planning. Even if reforms now getting a gingerly hearing should sweep the land, there would still be a need for federal assistance to those outside the profit seekers' ambit.

The fight for health care must continue. But it will continue in a changed climate. That is already something the Clinton administration has accomplished. Don't hold your breath for anyone to acknowledge it.

Garry Wills is a syndicated columnist.

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