The Price of Waiting for Health-Care Reform

September 20, 1994|By DAVID EWING DUNCAN

In Washington, they're saying time has run out to pass serious health-care reform. Wait a year, everyone says, so Congress can ''get it right.'' But a lot can happen in a year.

For starters, the nation's health-care tab will keep running, rising by $87 billion between this year and next. That's more than the federal government spends on crime and transportation combined; an amount so prodigious it would rank in the top ten of the Fortune 500, if it were a company.

Health care as a percentage of gross national product will also rise, from 14 percent to over 15 percent. Next year, the gross world product -- the GWP -- devoted to U.S. health care is expected to top 4 percent.

Delay will add as many as 5 million Americans to the rolls of the uninsured, pushing the total to at least 42 million, some dropping out because of cost, and others because of pre-existing conditions and changes in employment. And if you think this doesn't concern you because you're insured, think again, because the hidden ''tax'' those of us with policies pay to cover indigent care -- as much as 30 percent of our premiums, according to one study -- will also go up between now and 1995.

Millions of Americans will also lose their choice of doctor and hospital as they're shifted at work to managed-care plans that tell them which providers, drugs and procedures they can and cannot use. For some, these plans will cost less. But for the sick and elderly, and those who have come to depend on their own physician, saving a few dollars may be a high price to pay, particularly when Clinton-style reforms would have saved money for many people and guaranteed choice.

Waiting will further imperil academic health centers already facing economic hard times as insurers looking for cut-rate care turn to hospitals that don't have to pay for teaching research, and the lion's share of indigent care, and can thus charge less. Lacking subsidies promised in reform bill on the Hill, even the most renowed teaching hospitals are struggling. By 1995, some may be forced to close down altogether.

For some Americans, delay will literally mean a death sentence. Take Christina Macpherson, a 37-year-old mother of three small children in Santa Monica, California, According to a letter her husband sent to Rep. Pete Stark, D-Calif., she was diagnosed last May with multiple myeloma -- bone-marrow cancer -- only to be denied coverage by her HMO for potentially life-saving treatments.

Unable to pay $150,000 for chemotherapy and a bone-marrow transplant, Mrs. Macpherson might survive until 1995 only if Congress passes reforms this fall forcing her insurer to pay. Even with the treatment, doctors say she may die. But to exclude a young mother with even a slim chance, particularly when insurers routinely pay for expensive, high-risk treatments for seniors in their 70s and 80s, is an example of the misplaced priorities in a system lacking reform.

Worst of all, to table health care this fall could mean the end of federal reform for years to come. It's hard to imagine any presi- dent going mano-a-mano against the reform demon with anything approaching the vigor of President Clinton this past year. Not after the political pummeling he received for his trouble, in part from his own missteps.

This hardly means Mr. Clinton will give up on health care, though in the future he will tiptoe rather than stomp about, and will push for much more modest gains, particularly with a new Congress expected to be more Republican, more conservative and less eager to embrace government solutions on health care or anything else.

It's possible that Republicans will come back from this election feeling more secure in their larger numbers, and that Bob Dole and Phil Graham, wanting to look presidential rather than obstructionist, will work with the Democrats to pass real reform. But it's just as likely that they, along with Newt Gingrich in the House, will continue to resist initiatives by a weak Democratic president and a Congress denuded of up to several dozen Democrats, especially if the GOP believes it can clobber Mr. Clinton in 1996.

There is too little time before this session officially ends, according to leaders in both houses, for members of Congress to sort out their differences on sweeping reform. There are too many competing plans, say the leaders, and too many complexities to absorb.

Maybe this is true. But hasn't Congress just spent two years talking health care? Didn't it conduct thousands of hours of hearings and spend millions of dollars on reports, studies, bills and fact-finding missions? Or was this just window dressing to assuage a public concerned about health care, and not a genuine effort by lawmakers to do their homework?

The devil-in-the-details complaint is not the real problem on Capital Hill. Time and again, lawmakers have passed complex bills at eleventh hours, including federal budgets where slap--- details can have far-reaching ramifications.

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