A healthy start

July 31, 2002

NEARLY HALF the 300 Baltimore families recently surveyed by the Open Society Institute have no health insurance -- though 86 percent of them have a chronic medical problem.

That means they're carrying crushing debt from medical care, in some cases equal to half their yearly incomes. Not surprisingly, many don't seek medical care, and wind up in hospital emergency rooms when their conditions are worse, and more expensive to treat.

It's an unacceptable situation for a wealthy and progressive state -- particularly when the problem has been largely neglected for years.

Fortunately, some good ideas for change have been advanced recently by a coalition of advocacy, political and business groups that haven't always worked well together in the past. Actually, they've been downright antagonistic, so cautious optimism may be appropriate.

Led by House Speaker Casper R. Taylor Jr. and Maryland Business for Responsive Government (MBRG), this coalition of forces hopes to reorganize the state's Medicaid system and to use income tax credits that would allow the uninsured to buy health care insurance. A number of organizations, including the Maryland Citizens' Health Initiative, have signed on with enthusiasm tempered only by their interest in hearing more of the details.

Business interest in the idea grows as the cost of insurance grows -- and as calls for other approaches threaten businesses with costs they feel they can't bear.

The expanded insurance coverage under Medicaid will cost between $200 million and $400 million, according to Mr. Taylor. The higher costs are simple: More people will be covered if the income eligibility limits are raised, so the costs will go up.

Some of that expense will be covered, he has said, from a new program of shared expenses with the federal government. Mr. Taylor rejects -- at this moment, at least -- the call for a further increase in the cigarette tax. No tax increase of any kind is envisioned, he said. It's an election year, after all, and Mr. Taylor, like everyone else, may be avoiding harsh reality for political purposes.

Still, Mr. Taylor, MBRG and the Maryland Citizens' Health Initiative are moving with admirable equanimity into a difficult area. Too often, this state has promised expensive health care without providing the necessary financing.

Now, with virtually every aspect of the health system under pressure, a prudent and cooperative spirit is needed.

On this and other matters, Marylanders must decide how progressive and humane they wish to be -- and how pragmatic. The current health care system stresses almost everyone -- patient, doctor, hospital and government official -- without achieving the kinds of efficiencies and services they all want. The truth is that a good system needs constant attention -- and the nourishment of tax dollars.

Mr. Taylor's proposals, which he hopes to pursue step by careful step, have the virtue of addressing a need too long neglected by government in Maryland.

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