THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, August 21, 1994 TAG: 9408190030
SECTION: COMMENTARY PAGE: J4 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 60 lines
One of the reasons the Clinton administration has put forward for nationalizing the health-care-delivery system is that it will save money by eliminating insurance duplication, provide preventative health care for people who don't now have it and that ``universal'' health care will eliminate cost shifting whereby insured people now pay the bills for the uninsured. How much truth is there to these arguments? Very little, according to a study by the Dallas-based National Center for Policy Analysis.
The proponents of universal health care, including first lady Hillary Rodham Clinton, have long argued that if uninsured people had insurance, they would see their doctors regularly and that health problems would be nipped in the bud, before they have to seek expensive emergency room treatment.
Emergency room treatment certainly is expensive, but there isn't much evidence that universal health care reduces it. The latest issue of Mac-lean's, Canada's news magazine, reports that Canadian hospital emergency rooms are jammed. Universal coverage, it seems, encourages hundreds of thousands of Canadians to use emergency rooms as a surrogate family doctor. And even assuming that people did see their doctors more often, overall health spending is more likely to rise, not fall.
But what about ``cost-shifting,'' the payment of the bills of the uninsured by everyone else. In spite of all the attention this issue has received, no one has any real idea of how large a problem it is. The Congressional Budget Office estimated the cost of unpaid hospital bills in 1991 at around $20 billion. Although that number sounds large to most people, it represented less than 3 percent of total health-care spending that year.
Any savings in uncompensated care are likely to be eaten up by reductions already slated to be made in the Medicaid and Medicare payments to doctors and hospitals, as the government expands benefits under these programs and reduces the resources to pay for them.
Mrs. Clinton has even sought to appeal to what she perceives as middle-class resentment and has attacked the uninsured as ``freeloaders,'' getting a lot of free health care at everyone else's expense. What that overlooks, however, is that the working, uninsured person and his employer pay more in taxes than those insured by their employers. The latter are beneficiaries of the section of the federal tax code that gives employers a tax break for buying health insurance for their workers. No one has demonstrated that these additional tax revenues are less than the care the uninsured receive.
The Clinton administration is seeking to find a utilitarian justification for something it wants to do as a matter of principle, which is universal health coverage. But President and Mrs. Clinton are seeking to square an economic circle. They want to provide more benefits without (visibly) reducing anyone else's benefits or enacting a general tax increase. Based on previous experience, that cannot be done without resorting to health-care rationing, which the administration says will not happen under its plan. Far from saving money, any health-care plan Congress is likely to produce will raise costs, not lower them. by CNB