Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, April 8, 1994 TAG: 9404090003
SECTION: EDITORIAL PAGE: A11 EDITION: METRO
SOURCE: NEWELL FALKINBURG and C. ALAN HENRY
DATELINE: LENGTH: Long
The numbers used to justify this crisis mentality can be looked at in different ways. While there may be 40 million or so Americans without health insurance at any given moment, all Americans are guaranteed access to the health-care system - by law. And of those 40 million, 15-20 percent make more than $50,000 a year. While the president parades many individuals for whom the system has, sometimes tragically, failed, he doesn't like to discuss situations like the brother of one of the authors, who is young, healthy, making good money - and chooses not to buy health insurance. Is this family member a part of this crisis? I don't think so. Yet he is included in the crisis statistics.
There are significant problems, problems that are urgent and need attention. But there is no crisis that calls for an overhaul of our health-care system. And while we agree that change is needed, the choice is not the president's plan or nothing. Most of the problems of the current system can be addressed with straightforward, unobtrusive, market-based approaches. This system may have the flu - perhaps even pneumonia - but it doesn't need a lung transplant when antibiotics would do nicely.
The problems with our system can be lumped into two groups: cost and insurance availability. No one would argue against reducing the amount spent on health care in this country. However, in comparing what we spend with what other countries spend, the numbers can be misleading. Canada reportedly spends about 9 percent of gross domestic product on health care. However, a number of costs included in our figures are not included in theirs. Closer inspection puts the numbers closer. President Clinton suggests insurance paperwork is the chief culprit of excess costs and that reducing this would pay for his plan. However, insurance paperwork, while a huge problem that needs immediate attention, is only one part of the problem.
Other factors contribute to the high cost of care here, and reducing costs by addressing these problems will require choices we may not be ready to make. Among these problems are high technology, an aging population, large numbers of teen pregnancies and premature babies, the epidemic of violence. Do we want to limit the number of MRI or CT scanners? Do you want your family member to wait weeks or months for that scan? Do we want to limit the amount and kinds of care we provide to our youngest and oldest citizens? Do we limit the care provided an inner-city youth shot in a drug deal? Do we want price controls on medical providers, drugs, medical-equipment companies?
This is not to say the problem of cost is too complicated to approach. It should be dealt with where feasible. But a top-down, federalized approach will have only limited success. A decentralized market-based approach already has shown that costs can be limited. Competitive pressures are coming to bear on the medical marketplace, and cost increases are modifying. For any plan to succeed in controlling costs, there needs to be significant contact with and responsibility for those costs. We don't expect our auto insurance to pay for points, plugs and oil changes, yet we expect essentially the same thing from our health insurance.
To suggest that competitive pressures don't apply to the medical marketplace is to ignore the facts. Costs for elective plastic surgery have risen at much less than the costs of other medical services - because these services are generally paid for directly by the recipient. President Clinton's plan, as well as the current employer-based insurance system, essentially remove personal responsibility from the equation. The resulting unbridled demand for services will have predictable results in demand for services and in cost pressures.
Reforming the insurance market and the way individuals allocate money for health services (e.g. medical savings accounts) would limit cost pressures. To federalize the health-financing system would merely ossify an already inefficient system.
Access to health insurance is the second major problem in our health system, but one that should be easier to tackle. Most Americans have health insurance, purchased by their employer. However, the possibility of losing coverage because of a job change or loss or because of a pre-existing condition is a concern to many. For individuals or small groups, adequate coverage at a reasonable cost is simply unavailable.
Basically, people need health insurance that is stable, portable and personal. There are legitimate problems that can and should be addressed. But these problems can be addressed immediately by changes in insurance regulations and tax code. Some changes that could be made by simple modification of existing law:
Change the tax structure to favor individual ownership of health insurance instead of business ownership.
Require individual ownership of health insurance. The relatively few who cannot afford to buy it and cannot qualify for Medicaid could be provided with vouchers or tax credits.
Limit pre-existing conditions exclusions.
Establish community-based rating.
Eliminate barriers to small-business insurance pools.
Change the tax structure to allow establishment of medical savings accounts.
Finally, we should ensure that all children have insurance coverage through expansion of Medicaid.
The president would frame the health-care debate in terms of his plan or continuing with the current system. This is not the debate. Almost no one wants the health-care system to remain as it is. The debate is over the nature and degree of reform. The president's plan would impose a large dose of government into all areas of this vital segment of the economy. There are many other remedies to the problem that don't require massive government control, and would accomplish the goals that most Americans think are important: access and stability of their own health insurance; and cost of care. Significant change in the system - please. Government takeover of health care - no thank you!
Newell Falkinburg is president and C. Alan Henry is vice president of the Roanoke Academy of Medicine.
by CNB