Medicare woes tip of iceberg

July 02, 1999|By Marie Cocco

SO HERE we go. Again.

President Clinton sets out to boost Medicare for the baby boomers and give old people a big new benefit, prescription drugs, to boot.

This is a fine step. It is a necessary one, and one that has only a small chance of happening this year or next, given that Congress cannot even find a way out of budget inertia. So the fate of the new Medicare plan is quite uncertain, but there is something about it that is very certain.

Overheated chatter will crackle over the airwaves as if this small fix to a program that already works remarkably well is the single most important thing we should do about health care.

So many other headlines should draw louder screams.

Consider the one just last week that described how uninsured people and people whose HMOs deny certain care have been roaming from private drug trial to drug trial, desperately seeking free medicine -- however temporary its supply -- to soothe chronic conditions they can't afford to get care for.

Or the one about how a Long Island, New York, hospital ended its contract with a big HMO because it couldn't survive the cut-rate reimbursements. This left women about to give birth and grandfathers about to have surgery scurrying around in search of a bed in which to have a baby or an operation.

Or the one about how Medicare is still overpaying HMOs by the billions, according to an official new study, even as the HMOs cry poverty and drop half a million Medicare patients from their rolls.

There was one about how the American Medical Association, the doctors' lobby, decided it is mad as hell about professional humiliation endured at the hand of insurance companies and won't take it any more. The docs, of all people, voted to unionize.

There was one about how, in just 10 years, the number of Americans without insurance could jump to 67 million. It is 43 million now, having grown by about 10 million over the past decade.

These headlines all have something to do with health care, and so connect the dots.

"The health care scene is in chaos," said Quentin Young, national coordinator of Physicians for a National Health Program.

Dr. Young is 75 years old, a practicing internist, a former president of the American Public Health Association, a lifelong member of the AMA and a lifelong thorn in its side.

He protested when the doctors' group sanctioned the exclusion of black physicians from its Southern chapters. He protested when it opposed the creation of Medicare in the 1960s.

He sees in the union vote a primal scream against everything that's happened to American health care since Clinton's proposal for universal health insurance went down in flames.

"Nothing took its place. Nothing was there to organize and discipline the system. So the market solution prospered, but it is a disaster," said Dr. Young.

Now Dr. Young is an admitted rabble-rouser. So if his rhetoric singes the ear, listen instead to Jordan J. Cohen.

He is the president of the Association of American Medical Colleges and, in a commencement address last month, he told med school graduates they must commit themselves to a struggle for universal health insurance: "Each painful anecdote about the plight of the uninsured points up a glaring failure of our democracy."

In an interview, Dr. Cohen linked the "growth in the uninsured to dependence on the marketplace to transform America's health-care system."

What could be more obvious? Markets control costs; they don't provide care. Companies answer to shareholders, not patients.

There is only one way to answer the primal scream rising up all around and it would, conveniently, make it unnecessary to fight over whose parent should be lucky enough to get a prescription filled. It's time for universal health insurance run by the federal government. And if this is too much for the politicians to handle, we need to replace them.

Marie Cocco is a columnist for Newsday.

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