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Paralysis in Health Care
Early this year Congress and the White House entertained dreams of passing all kinds of health care legislation. President Bush and Senator Edward Kennedy were supposedly working on a patients' "bill of rights." There was even talk of enacting a prescription drug benefit for the elderly. But such talk has vanished. Instead a sober recognition has settled in Washington that little can be done to expand or improve health coverage while health care costs spiral out of control and the federal budget sinks deeper into deficit. Lawmakers seem to be betting that voters will not punish them for inaction. But they cannot put off the issue forever. A decade ago, when the cost of health care was also soaring, many experts were sure they had a solution — managed care and competition. A revolution in health care delivery took place, and costs indeed seemed under control. But in the last couple of years they have gone back to rising at double-digit rates. Even the experts are shaken, because there is no magic solution this time around. Health maintenance organizations and insurance companies are not high on anyone's list of favorite enterprises. But in the current environment, lawmakers seem loath to add new requirements like a patient's right to sue, or parity between regular health care and mental health benefits, because of the cost. Elderly people who came out of the last election with the impression that they would inevitably get help with the cost of prescription drugs may be in for a disappointment. The Bush administration proposed spending less than $200 billion over the next 10 years — a ridiculously low sum given the public's expectations. Democrats are looking at plans ranging up to $600 billion over the same time frame, but that seems costly unless Congress is willing to reconsider the tax cuts due to take effect in the next several years. The number of uninsured Americans remains at 39 million, but if costs are not brought under control, that number is certain to go up again. In attempting to address the problem, Democrats and Republicans are caught in the same ideological divide that has prevented action for years. Republicans favor tax cut incentives for individuals to buy health insurance wherever they want. Democrats argue that such a system favors the young and healthy, because older and sicker patients will have a tough time finding affordable insurance. Instead, Democrats favor subsidies for patients to use in joining employer-based or state-sponsored health insurance programs. That approach makes the most sense, because it preserves the idea of a common insurance pool in which risks are shared and costs are kept down for all participants. The next round of the health care wars will be fought over whether trade promotion legislation should provide health benefits to Americans who lose their jobs because of imports — and if so, what kind. In the meantime, in this holiday season, Congress members had better take the time to listen to voters. They are likely to discover that their patience is diminishing. Sooner or later, the demand for health care is going to be high on the agenda again. It could happen before the election in November.
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