Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, March 7, 1990 TAG: 9003071877
SECTION: EDITORIAL PAGE: A-6 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Long
That omission, some critics said, renders the plan dead on arrival at Capitol Hill. The panel - also called the Pepper Commission - was supposed to recommend not only ways of making health care more available, but specific methods of financing them as well.
Given the success of the Reagan-Bush anti-tax policies, and the lack of fiscal courage in Congress, it may be more discreet now for the plan's backers to avoid calls for this particular levy or that one. The price tag alone is daunting enough. Meantime, even if this plan is not DOA, it needs exploratory surgery.
It is unclear, to begin, whether its proposals to bring coverage to the estimated 37 million uninsured Americans and their dependents would make much difference.
The plan mandates that businesses with more than 100 employees provide private health insurance or contribute to a public program; businesses with 100 or fewer employees would simply be encouraged, by tax credits and other means, to provide health insurance.
The public program is intended to replace the federal-state Medicaid program, which probably would be good. Medicaid is administered by the states, with wildly varying levels of eligibility. Only about 42 percent of the poor qualify for it. A uniform national standard is preferable to the existing hodgepodge.
How much the new public fund would get from the private sector is problematical. Most businesses with 100 or more employees already offer health-care coverage to their workers. The way they do it is part of the problem: Nearly 85 percent of large corporations pay those health costs themselves rather than contract with a private insurer to do so. The private insurers are left with a smaller pool that poses greater risks; many of these people work at low-wage, temporary jobs, and their health is more likely to be poor.
If large businesses were compelled to deal again with private insurers, that would expand the pool of insured and perhaps put coverage within the reach of more small businesses. But there are philosophical (and maybe legal) difficulties posed by government compulsion.
Moreover, simply giving more people the key to the hospital or doctor's office isn't a final solution. The health-care system can't care adequately for the patients it has now; that's one reason costs have zoomed out of proportion to the rise in other living expenses. More clients mean more demand, more stretching of resources and continued if not accelerated increases in cost.
Most of that cost now is passed on to the federal government (which pays 40 percent of all health-care costs), a private insurer or an employer. Third-partying has contributed mightily to overuse of health care and negligence about costs; there need to be larger deductibles on insurance coverage and other means of moving people to greater concern about the expense and appropriateness of the care they receive.
The system also has large problems with quality: The nation will invest some $661 billion this year in health care --more than $2,200 per American--yet the United States compares poorlywith other industrial nations in health indices such as infant mortality. All that money is not buying the kind of health it should.
One reason for that is misallocation of funds. This doesn't mean people are stealing or mismanaging money. It means that as a society, we don't put enough into preventive care: keeping people from getting sick; protecting the health of the most vulnerable, such as expectant mothers and small children; and discouraging bad practices such as smoking, drinking or eating to excess, and abusing illegal drugs. Instead, we wait until people fall ill; then we throw the panoply of medical knowledge and expensive technology into making them well.
Too often that means sustaining life in very sick people - in many instances, for too long. In his series of articles on intensive care in this newspaper, medical writer Charles Hite documented several cases in which breath and heartbeat have been prolonged, usually in the very old, by intrusive and painful (some might say meddlesome) techniques.
It's the job of medicine to save lives. But at what point can such resources be better used? As Hite notes, intensive-care hospital units account for nearly 25 percent of all health costs in this country. Not all admitted to ICU are hopeless cases. But much of this expensive care is devoted to people who should be allowed to die quietly, peacefully and with dignity.
Deciding how to deal with those cases poses difficult decisions for medical staffers and patients' families. Not all can live; some must die. Similarly, not all can get the same level of other kinds of care; it simply is not available. This means that other difficult decisions lie ahead.
Just now, care is being allocated in terms of economics, with the affluent and the politically influential getting the most care. If society is to try allocation on a more equitable basis, there seems no way of avoiding the question of some kind of rationing. It is doubtful the Pepper Commission's plan faces up to that. It is a hotter potato, even, than taxes.
by CNB