Health Care

Washington.--Critics who complain that President Clinton's health-care plan has ''too much government'' are onto something, but they don't have it exactly right. The problem isn't too much government; it's too much politics. The Clinton plan will force society to make explicitly, through the political system, decisions on painful questions like limiting choice and rationing care that will be made in any event.Alternative plans will make these same decisions covertly, and possibly less sensibly.

If you are lamenting the cost and confusion of your Medicare or HMO health-care plan, just remember: It could be worse. You could be facing more difficulties in the Canadian health-care system. Its government-financed system is not the utopia it appears to be.Granted, Canada provides basic care and pays for everyone, no matter each citizen's employment status or income level. However, as I found out during a recent international conference on aging there, problems abound.An article in the National Post summed up the current struggle: "After five years of deep government cuts to health care that have affected every province and virtually every community, public confidence in government-financed medical care is faltering as more and more Canadians experience delays in receiving medical care and endure over-crowding in hospitals."

ANNAPOLIS -- In an effort to curb health-care costs, Maryland officials are poised to award a contract that would allow one company to screen all state employees seeking mental health or substance abuse care.State officials say their plan would save at least $3 million just in administrative costs by paying one firm to provide services now offered by 13. And they say it would produce further savings by discouraging unnecessary treatment -- even though the plan would actually expand coverage for many state workers.

ALL the ingredients are in place for the making of another fine mess in the best Laurel and Hardy tradition.First, almost every politician in Washington needs something that can be called a "health-care bill" and needs it quick. In time for autumn campaigning, in fact.Second, there is no consensus in Washington about what this wondrous "health-care bill" should do or be.Third, there is no pronounced sentiment among the public either about what a "health-care bill" should do. This is because the public has only the foggiest notion of what's on the table.

In a recent column I documented the woes of a U.S. health care system that is the shame of the industrialized world. I continue to question how we can spend $2 billion a day, more per capita than any other society, and still wind up with 60 million Americans getting little or no meaningful health care and with 60 million more with insurance that won't meet the test of serious illness.Now I'm going to explain why we're in such a health-care mess:* Government intervention over the last 30 years has been half-hearted and ill-conceived.

For White House spin doctors, Donna Shalala's testimony that 40 percent of the American people will pay more for medical insurance under the Clinton health care plan must have been as welcome as a dose of castor oil. That the Health and Human Services secretary was being candid and merely reiterating, with minor changes, estimates presented earlier by Hillary Rodham Clinton was beside the point. Her message clearly upstaged Bill Clinton just as he came to Baltimore Thursday to begin a year-long selling job on the massive legislative proposal he had given Congress the day before.

WASHINGTON -- At the close of the winter meeting of the nation's governors here, Republican Gov. Carroll Campbell of South Carolina, the group's chairman, was asked whether in the conversations they had with President Clinton on health-care reform, the president had ever reiterated his State of the Union veto threat to Congress."

Architects of the health-care summit that opens today in Annapolis hope to start the process that could provide affordable medical care to 570,000 uninsured Marylanders.The sponsors say such a dramatic revamping of Maryland's medical-delivery system could make the state an example for the nation."I think it's a golden opportunity," says Del. Casper R. Taylor, D-Allegany, the chairman of the House of Delegates' Economic Matters Committee.The planners hope to lay the groundwork for one of three systems that conceivably could give uninsured Marylanders access to medical care.

Joseph A. Califano Jr., former secretary of health, education and welfare, told over 200 business leaders attending a recent Baltimore County Chamber of Commerce meeting that it is time for major rethinking on how health care is delivered in the United States.Speaking at the Chamber breakfast sponsored by Maryland Blue Cross and Blue Shield, Mr. Califano said that by year-end, Americans will be spending $2 billion a day on health care."Most troubling," Mr. Califano said, "is the overwhelming evidence that at least 25 percent of the money Americans spend on health care is wasted."

NOW that the broad outline of President Clinton's health-care plan has emerged, it is important to understand what sorts of obstacles, roadblocks and potholes the plan will encounter as it wends through Congress.The easiest way to get a handle on what lies in store is to take a peek behind the veil that was draped around the process by which the plan was born.From February to May, I served as one of the 500-plus members of the Domestic Health Care Task Force advising Hillary Clinton on health-care changes.