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

DATE: MONDAY, August 29, 1994                   TAG: 9410120009
SECTION: EDITORIAL                    PAGE: A4   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

DON'T GIVE UP ON HEALTH CARE

THE CURE mustn't be worse than the illness. That thought is causing Americans to dither on health-care reform as they continue to be bombarded with nightmarish scenarios from every group with an interest in preserving the status quo.

And that dithering is why Congress is on vacation now with the issue unresolved. No need to fear facing your constituents when they are conflicted about what should be done.

Of course, not all the fears conjured up about various reform proposals are groundless. Some Democratic provisions would be far too cumbersome, far too costly. Change in any case involves risk; there's the law of unintended consequences to consider. And what the president and lawmakers are talking about changing is a system now providing the finest medical care in the world. That must be protected.

Even so, the status quo will have to change. It already is changing. This much is evident in the steady migration of businesses to managed-care plans and HMOs for employees (if they offer them health insurance at all); in the rise in co-payments required of those using medical services; in the trimming of staffs among care providers and the efforts of insurers to squeeze out those with the costliest health problems.

All these changes point to the fact that medical care in America is growing too expensive. Something's got to give.

Yet the leveling-off in health-care inflation over the past year should not be taken as a sign that the system is fixing itself. Far likelier, it mirrors similar cooling-off periods when reform was pushed in the past - periods that ended when the pressure for change did.

Americans still say they want health-care reform, even if they don't know precisely what they want. The current system, which leaves millions uninsured, remains unfair and inefficient. The fortunate majority that does enjoy adequate coverage remains vulnerable to joining the have-nots with a change in jobs, spouses or health.

So a course of treatment is still required. On today's Commentary page, Joseph Califano outlines one that recognizes the need, first, to do no harm.

Califano, who served in the Carter and Johnson administrations, argues for employer mandates, starting with large companies that already offer health insurance and phased in until all workers have a basic benefits package; Medicare coverage for the poor and unemployed, along with a phase-out of Medicaid; insurance reforms that would ensure portability and prohibit exclusions for pre-existing conditions; a meaningful increase in the cigarette tax; and, key to success of the other reforms, a commitment to making affordable health care available to all Americans.

Far from constituting socialized medicine, as the reform obstructionists claim, employer mandates would provide the horsepower to drive the system toward cost containment by harnessing market forces to the task.

Indeed, just as crucial to a sound plan is Califano's warning against "attempts to regulate every nook and cranny of the system." We've seen enough bureaucratic micromanagement from Washington. It doesn't work.

When Congress returns from its recess, it should dismiss reports now circulating that health-care reform is dead, and prescribe a remedy that emphasizes, as Califano puts it, "a gradual and streamlined approach."

That's the kind of approach Virginia's congressional delegation ought to be able to support, and sell to their constituents.

by CNB