Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, June 30, 1994 TAG: 9406300120
SECTION: NATIONAL/INTERNATIONAL PAGE: A6 EDITION: METRO
SOURCE: PETER G. GOSSELIN BOSTON GLOBE
DATELINE: LENGTH: Medium
Lost in the political tactics and maneuvering that now consume Congress is this stark fact: Many of the provisions that are being jettisoned in the search for votes on Capitol Hill are those that would most change how Americans obtain their health coverage and most directly attack the spiraling costs of American medicine.
What survives, at the moment, of President Clinton's once-grand scheme for change are mostly more traditional proposals for billions of dollars in new subsidies and government programs to cover the uninsured.
``We're moving away from trying to reorganize the health care system to injecting some more money into the existing system with a few changes of the rules, but nothing fundamental,'' said Joseph P. Newhouse, an economist and health policy professor at the Harvard School of Public Health.
Depending on your point of view, that may be great news. The president's proposal for revamping virtually everything about the nation's health care system left many fearful that Washington was reaching too far, too fast.
But as the outlines of what could still pass Congress begin to emerge, there is something familiar about the result. It is almost as if Congress and the public are ready to do what they did in approving Medicare and Medicaid three decades ago and spend more money on health. But they are only willing to take the most perfunctory of bows to the lessons learned about what such programs can do to national health expenditures and federal deficits.
The compromises ``are throwbacks to an era when we thought our problem was we weren't spending enough on health, not too much,'' said Paul Starr, a Princeton sociologist who has written an influential book on the rise of the American medical industry and helped the White House design its plan last year. ``We don't seem to be learning anything from history.''
To be sure, many of the compromises, while retreating from the Clinton plan, would still involve gargantuan change. One being debated by the House Ways and Means Committee, for example, would require Washington to shell out a half-trillion dollars in health insurance subsidies for poor people between 1998 and the year 2002.
In addition, although they have little evidence for their claims, the authors of the major compromises insist that their proposals would profoundly improve the health care system without the kind of disruption they say is entailed by the president's plan,
Nonetheless, virtually all the compromises would stop substantially short of what the president originally proposed and leave the broad outlines of the current system largely intact. In effect, of two major goals that Clinton set out in unveiling his plan last fall - guaranteeing health insurance for all, and controlling medical costs - most would give up on the latter and cut back on the former.
Despite such setbacks, many observers think Clinton could still win passage of legislation to substantially expand insurance coverage. Although most of the compromise proposals drop the idea of a mandate as a means of financing subsidies for the poor and others, they call for a new cigarette tax and Medicare and Medicaid savings to fill at least part of the gap.
However, many analysts warn that money alone is not the problem, and that if government subsidies flow into the current health system, they will be eaten up in a few years by higher prices and increases in the volume of medical services people buy.
In some sense, Clinton and his wife, Hillary Rodham Clinton, have contributed to the narrowing of the overhaul effort in recent weeks by focusing exclusively on the issue of expanding health coverage and remaining silent on almost every other aspect of the reform drive. In this, aides said, they have little choice if they are to salvage any kind of victory on the issue.
by CNB