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

DATE: SUNDAY, June 26, 1994                   TAG: 9406280092
SECTION: EDITORIAL                    PAGE: E2   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

REFORM REQUIRES COVERAGE FOR ALL

IN DELIVERING his health-care reform plan to Congress, President Clinton said he would be willing to compromise on the means of achieving it, but vowed to hold firm on one bottom-line goal: universal coverage. That is still the goal he and the nation should not lose sight of.

A proposal unveiled Friday by Democrats and Republicans on the Senate Finance Committee would achieve some of the easier reforms Clinton has proposed, but would stop short of universal coverage. That's not good enough. America has never come this far toward assuring comprehensive, universal coverage like other industrialized nations have. Congress must not let this opportunity slip away.

Months of intense lobbying by special interests have surfaced the complexities and inherent dangers in overhauling such a vast and critical operation as the nation's health-care delivery system. Unfortunately, the debate has done as much to obfuscate and frighten as to educate and enlighten. And the struggle has been more over who will win or lose money than how best to sustain quality, cut costs and insure the uninsured.

Doctors and hospitals that have thrived on fee-for-service delivery raise alarms about lack of choice and rationing if any attempt is made to rein in costs. Insurance companies that have made huge profits on coverage for the healthiest warn ominously of a new, monolithic government bureaucracy. Small businesses forecast doom for themselves and a rise in unemployment if employer mandates are put in place.

All of which leaves the public confused and conflicted. While coverage for the nation's 37 million uninsured - many of them the working poor and children - remains important, the middle class doesn't want to see its own level of care reduced or their costs increase.

But the status quo ain't what it used to be. As medical costs grow out of proportion with the rest of the economy, consumers already are picking up more of the bill - as they should. And they already are finding that coverage while they are young and healthy can cost considerably more or disappear altogether as they get older or less healthy. Physicians already are being second-guessed by profit-driven insurance companies, that already hit doctors and patients alike with a formidable wall of confusing paperwork. And health care already is being rationed, though not in any rational way.

If universal coverage is right, and it is, how to pay for it? People should not be denied insurance for pre-existing conditions, but they should contribute to the pool that shares the risks while they are healthy. And, given that no one likes higher taxes, and most people with health insurance are covered through their workplaces,employer mandates seem like the quickest way to reach universal coverage.

Some small businesses would be hurt, though the dire forecasts appear to be exaggerated. The federal government can cushion the impact. And let's not forget that any suffering is mitigated by a fairer sharing of health-care costs. Businesses that do not provide coverage now are, in effect, being subsidized by those that do.

Socialism America doesn't need. But managed care in health-purchasing cooperatives (without the price controls Clinton wants) would help. Combine that with greater emphasis on preventive and primary care, tort reform to reduce defensive medicine, standardized insurance forms and portability of coverage, better consumer information to promote competition, and some consumer stake in paying for care - and such a reform package would encourage health care that is both high in quality and more cost-effective . . . for all Americans.

by CNB