Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, April 29, 1993 TAG: 9304290497
SECTION: EDITORIAL PAGE: A-11 EDITION: METRO
SOURCE: RAY L. GARLAND
DATELINE: LENGTH: Medium
But translating political rhetoric into bureaucratic reality in a nation of such incredible diversity is something else again, as the president and first lady are discovering as they contemplate the hard choices they must make in delivering on their promise to make health care universally available and easily affordable.
Originally promised as a first order of business for the Clinton administration, the deadline for unveiling the health-care proposals has been steadily pushed back, and the talk now is that full implementation - even assuming a cooperative Congress - will be closer to the end of Clinton's term than the beginning.
Given the difficulty of the subject, such delays aren't unreasonable, but they do illustrate the danger of promising so much on matters to which you have given but fleeting thought.
In the heyday of the politically incorrect, Old Gold cigarettes used the slogan, "We're tobacco men, not medicine men." The Clintons might update that to "We're political persons, not medical persons."
But let's give them credit for wanting the best and most affordable health care for all citizens. They may not know how to bring it about or persuade taxpayers to pay for it, but they do understand the politics of making people look to government for what ails them.
National health insurance funded by indirect levies such as a national sales tax would be the mother of all entitlements, joining 100 percent of the people in a single program.
If you want to know the future of such an endeavor, examine the history of Medicare. That started less than 30 years ago with the sweeping promise of covering most medical costs for senior citizens with extremely low premiums and absurdly low deductibles.
It didn't take Congress long to realize that honoring this commitment would require more money than they were prepared to raise in taxes. After years of sliding more and more costs on to recipients, and slicing away at payments to providers, we have a system awash in paperwork trying to reconcile tens of millions of small claims, leaving few on either side very satisfied.
Wouldn't it have made more sense to have started Medicare with a high deductible, say $750 a year, adjusted for inflation, and then have the government cover everything beyond that?
There are two reasons why the cost of medical care has far outstripped ordinary inflation. The first is vast improvements in technique, witnessed by the fact that the number of hospital beds per 1,000 population has declined by 50 percent since 1956. The second is that here is one of the few areas of the U.S. economy where normal market forces of price competition and shopping around do not operate very well.
One reason those normal market forces operate so poorly may be that the vast majority of Americans have little incentive to question medical charges or procedures. When somebody else is paying, it's only human nature to say, "Why not?"
The great challenge to the Clintons should be to restore, insofar as practicable, the vitality of those normal market forces. But they are virtually certain to look in the opposite direction of a greater role for government. Why? Because all the good politics reside there. Both patients and providers look for a sugar daddy and trust they will get more than they have to give up.
If you accept the premise of 37 million uninsured, that still leaves more than 200 million enjoying some of the world's best medical care. And it turns out that the vast majority of those who are uninsured at any given time re-acquire coverage within 12 months.
There is a place for national health insurance that covers extraordinary costs, leaving run-of-the-mill charges to be paid by individuals or private insurance carriers. If national health insurance would take over when a person has incurred charges exceeding, say, $15,000 in any one year, then the cost of private insurance and problems associated with obtaining it should decrease significantly.
Once you define national health insurance as covering only extraordinary costs, the problem of how to pay for it becomes much smaller. The fairest system of funding would be a surcharge on the amount of federal income tax due. That is, $1,000 in taxes due might require a 10 percent premium for the national health insurance trust, or $100. $10,000 in taxes due would require $1,000, etc.
There it would be, staring people right in the face, inevitably rising each year. This would be far preferable, however, to the Clinton razzle-dazzle of hidden taxes that he hopes will scarcely be noticed. The point being, when you connect a benefit with what it costs on a self-financing basis, people get very realistic about what they demand.
Ray L. Garland is a Roanoke Times & World-News columnist.
by CNB