As Health Care Reform Fails, the Problems Fester

October 02, 1994|By JOHN FAIRHALL

When Senate Majority Leader George J. Mitchell declared health care reform dead last week, Lucy Albert became one of the mourners.

She does not agree with the many lawmakers who say there's no need to rush. She has five children, and for almost six months this year her family didn't have health insurance because her husband was unemployed and they couldn't afford it.

"I'm sorry, but people inside the Beltway do not know what life is really like," says Mrs. Albert, who lives in Joppatowne.

"I had two teen-agers, one of whom was driving a car. I was paranoid. I needed some kind of coverage for my children. You never know what's going to happen."

Congress' inability to act on health care legislation has profound consequences for millions of ordinary Americans like the Albert family.

39 million and growing

Health care specialists say that the number of Americans without insurance, now 39 million, will grow. Health care and insurance costs will escalate, threatening the ability of employers to cover workers and driving up the cost of the taxpayer-subsidized Medicaid and Medicare programs serving the poor and elderly.

Senior citizens will not receive what they had expected from health reform legislation: a prescription drug plan and a new home care program to help them stay out of nursing facilities.

"I was very disappointed," says Jeanne Pejeau, 66, a Bethesda resident who provides around-the-clock care at home for her husband, Robert, who has Alzheimer's disease.

She simultaneously cared for many years for her mother, who also had Alzheimer's and who died last October.

Because Medicare pays little for home-based care, Mrs. Pejeau dipped deeply into her diminishing savings to pay $19,000 last year for health aides who came to her house to assist in caring for her husband and mother.

"It would be glorious, it would be the greatest thing in the world if we could get some kind of assistance from the government," Mrs. Pejeau says.

Only the wealthy can truly feel secure.

Shake-ups in industry threaten the jobs and health benefits of millions of Americans. Last week, London Fog announced it would shut two plants in Maryland and scale down a third, bringing to 1,100 thenumber of company workers laid off since January.

"It's going to be tough," says Carmen S. Papale, regional manager of the Amalgamated Clothing and Textile Workers Union. The workers earned a base wage of $8 an hour, but they didn't have to pay for health insurance that included dental and eye care and prescription drugs. "I don't know what they're going to do," Mr. Papale says.

Even if these workers land new jobs, they're not assured of good health benefits. More and more employers are scaling back their health plans or deciding not to provide one because of the rapidly rising price of insurance -- which can cost more than $5,000 for family coverage.

Depending on charity

Those workers who don't find jobs ultimately will depend on charity care. In many cases they'll wait until they're sick and go to hospital emergency rooms, the most expensive source of treatment. Hospitals will pass this cost on to patients with insurance, causing insurance premiums to go up.

Congress' failure to act also means that insurance companies can deny coverage to sick people. It means that small companies will pay more per worker than large companies. It means that academic medical centers such as Johns Hopkins and the University of Maryland will not receive the financial assistance for teaching and research that had been earmarked for them in the leading House and Senate health reform bills.

"It's unfortunate that Congress was unable to address some of ** the fundamental issues that certainly need to be addressed," says Dr. James A. Block, president and chief executive officer of the Johns Hopkins Hospital and Health System.

Dr. Block and other health care experts note that even though Congress couldn't agree on reforms, many changes are occurring in the marketplace.

Health maintenance organizations are offering less expensive care than traditional insurance plans. Doctors are being encouraged to perform more preventive care. More surgery is being done on an outpatient basis, and patients are going home from the hospital sooner.

"A serious gap'

But marketplace reform is geared to lowering costs. It "does not address fundamental issues," says Dr. Block, such as the huge problem of people who lack insurance and the need to pay for coverage of low-income people.

Nor will the marketplace respond to the demands of "biomedical research, education, overwhelming public health problems like AIDS and drug addiction, the costs of which are falling on doctors, hospitals and other health care providers without adequate reimbursement," the Hopkins leader says.

In Dr. Block's view, there is a "serious gap and a serious need for regulatory balance" which only government can provide.

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