Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: FRIDAY, September 24, 1993                   TAG: 9403170011
SECTION: EDITORIAL                    PAGE: A10   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

FINALLY, A PLAN FOR HEALTH REFORM

After so many false starts, delays and trial balloons, the long-awaited unveiling of President Clinton's reform plan Wednesday night might have been anticlimactic were the need less urgent or the call for change less far-reaching. But after seven months of intense study, Clinton laid out a plan that would address a lot of what is wrong with the nation's medical system, with assurances that it wouldn't destroy what is right.

And Congress just may be ready to act. What is most remarkable and hopeful about this initiative is the overwhelming consensus, among politicians and among the American people they represent, that the nation must have two things: universal, comprehensive health-care coverage, and some control over soaring costs.

While Congress picks apart the details of the administration's program and scrutinizes the costs, it cannot lose sight of both overriding goals. Cost-containment would be necessary for the country's economic health even without an ambitious plan to bring 37 million Americans who are now uninsured under the protective coverage of health insurance.

Indeed, American businesses have been sending up warning flares for years that the current system is getting too expensive to sustain if they are to remain competitive in the world marketplace. Even Americans who have adequate coverage today cannot feel secure that they will have it when they need it tomorrow.

So a government promise of "health care that is never taken away - that is always there" - is a big promise to all Americans. To fulfill it, savings are essential.

Whether the savings Clinton promises in his managed-care plan will prove enough to ease the pressure on those already paying the insurance bills, while bringing into the system 37 million new insured Americans, is certainly debatable. Congress will not and should not swallow the administration's program whole, without scrutinizing the projected costs and savings.

What it must not do, though, is allow itself to be scared away from making meaningful changes by the already intense lobbying efforts of groups defending the status quo because they profit from it. The status quo is not sustainable.

Clinton has offered his plan - health alliances nationwide, mandated provision of coverage by employers, subsidies for those who need it, spending caps for everyone - as a starting point. It is a thoroughly studied, well thought-out starting point, but a plan subject to revision, nevertheless. Basic elements of the program that he outlined, though, must be retained:

There must be more effort and resources put into preventing serious illnesses and less into heroic measures needed to deal with the consequences of failing to do this.

There must be serious incentives to change public behavior and attitudes, with consumers taking responsibility for their health, and sharing in the cost of maintaining it.

There must be legal reform to change the incentives for doctors to practice defensive medicine, which results in so many unneeded and expensive tests.

There must be a drastic reduction in administrative overhead, and a simplification of paperwork. A one-page, standard health claim form is badly needed.

There must be some cost-benefit analysis associated with medical care. The cost of prenatal care, for instance, is tiny compared to the cost of caring for low-birth-weight and premature babies in hospitals. And the cost of extending life when there is not much of it left to live must be reined in compassionately, but realistically.

There is discomfort, in some cases pain, associated with all of these remedies. The administration has made an honest effort to listen to the fears not only of those in desperate need of health insurance, but of those who stand to lose in the effort to spread that net further. The president has expressed a willingness to keep listening, and to work with Congress to come up with the best possible program for universal health care.

Whatever the final form of that care, it is clear that the American people want the security and are willing to pay for it, if the costs can be contained. Together, the president and the Congress must find a way to provide it. The time to do it is now.