Senate Majority Leader George Mitchell says it`s the most-mentioned topic when he goes home to Maine. Rep. Dan Rostenkowski recalls a German native who says his country does it better than the United States. Rep. Marty Russo is frustrated by the problems his family has with it.
”It” is the American system of health care and the ambivalent relationship Americans have with their doctors, hospitals and insurers. It`s a system that provides some of the best care in the world, but at a huge price, and not to all Americans.
Almost everyone agrees it needs to be changed, but virtually no one agrees on how.
As a result, a dramatic revamping of the way Americans use doctors and hospitals is at least years away. But congressional leaders hope to make some minor changes in the next couple of years, though conflicting interests probably will prevent it this year. They foresee radical changes by 2000.
The problems range from the 33 million uninsured Americans to the huge bite health care takes out of the nation`s economy. The proposed solutions range from an entirely government-run national health-care system to a modest assist to small businesses in providing insurance.
Everybody is talking about it, from Capitol Hill to the most remote corners of the nation.
One Washington professional who lost his job worried aloud about the loss of health insurance for his kids, not the loss of his income.
A 62-year-old early retiree from Maine, who is too young for Medicare, plans to cancel his private health insurance because he can`t afford it. He`s worried, too. ”Sure, I`m in good health now,” said Arthur Arsenault of Lisbon Falls, Maine. ”But who knows at my age?”
Government`s ability or desire to do something about health care can be divided into long-term and short-term goals.
In the short term, congressional leaders acknowledge, there is only a little that can be done because of cost constraints and the well-entrenched medical and insurance industries. But by the end of the century, experts say, things must change. That`s because health care, which eats up about 12 percent of the nation`s gross national product, is expected to swallow nearly 20 percent by 2000 if nothing is done, according to the Congressional Budget Office.
”Do you think we can ignore this until the year 2000?” asked Rostenkowski (D-Ill.). ”If you do, you`re crazy.”
Rostenkowski prefers making small, incremental changes in health care until the system is revamped-possibly beginning this year in the Ways and Means Committee, which he heads.
Russo (D-Ill.), on the other hand, is tackling the problem wholesale, proposing a universal, federally financed health-insurance system.
”The private sector has had it for all these years and look where it`s taken us,” he said. ”They had their chance and they screwed it up.”
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The Congressional Budget Office, in a report less colorful than Russo`s claims, says the nation`s health-care costs have risen dramatically because of a number of factors: an aging population, more effective and costly medical technologies and the ”failure of the normal discipline of the marketplace to limit” the quantity of health care provided because consumers don`t have to pay for all of it.
Insurance companies, strapped by the increasing cost of health-care services, have responded with cost-containment procedures of their own, including requiring second opinions for many services and raising premiums and patients` co-payments.
Mitchell (D-Maine) says part of the problem is consumers` understandable reluctance to look at costs first.
”When you buy a car, you look around and the first thing you ask is price,” he said. ”When you are very sick, you don`t look around and you don`t look at price.”
Mitchell and several other senators plan to propose a bill in the next few days that would require private employers to provide their workers with health insurance or to pay a 7 percent payroll tax into a statewide pool to cover the uninsured.
The so-called pay or play insurance-system bill could come to the Senate floor this year, but observers are not optimistic about passage. ”I`m going to try,” Mitchell said, refusing to be more positive.
”This concern is expressed to me more than any other-over time, this persists,” he said. ”I believe the agenda of the American Congress should be that of the American family.”
Mitchell and other Democrats excoriate President Bush for not joining the national health-care debate or taking the lead in it. Bush, prior to setting out any sort of health agenda, has asked Health and Human Services Secretary Louis Sullivan to work up proposals for him to consider.
Arnold Tompkins, counsel to Sullivan`s department, said it is unlikely anything can be enacted this year. He also said Sullivan prefers building on the current public-private health-care system, not replacing it with a federal system.
Along those lines, Sen. John Chafee (R-R.I.) is formulating a proposal that would expand health insurance voluntarily by giving incentives to small businesses to provide the insurance for their workers.
The 12 percent of its gross national product that the nation spends on health care is more than other industrialized countries spend, according to the Congressional Budget Office. Canada, by contrast, pays about 9 percent.
Nevertheless, Rostenkowski says plans such as Russo`s ”won`t fly because it`s too big a bite of the apple.” He favors taking ”baby steps”-possibly this year-to attack the problem of Americans who have no health insurance. He refused to be specific for fear of stirring up powerful medical and insurance lobbies prematurely.
”I`m not talking about universal health care,” he said. ”I think we could do something that would lay the predicate for a universal health proposal that could be debated in the next election.”
Republicans point out that the debate is as much among Democrats as between Democrats and Republicans, since Democrats are not agreed on a single proposal.
”There`s not a consensus out there,” noted Tompkins, who said the GOP is not worried about losing the issue to the Democrats until the Democrats can unite themselves.
Rostenkowski recalls a Ways and Means Committee seminar he attended at which Princeton economist Uwe Reinhardt, a native of Germany, recalled that he was poor as a boy but his parents never had to worry about taking him to the doctor since the government paid for it. ”`I am now a citizen of this country,”` Rostenkowski recalled Reinhardt saying. ”`And I am ashamed that a boy or girl in a similar situation has no government to help him.`
”At the conclusion of the story you could hear a feather drop on the floor,” Rostenkowski said.
For Russo, the matter has struck closer to home. His sister-in-law was injured in an accident during a family ski trip. Though she was insured, the hospital insisted that Russo come up with $850 up front before she could undergo an expensive test.
”Even the hospitals are saying, `We don`t trust you,”` Russo said, adding that paperwork often takes so long to process through insurance companies that hospitals are unwilling to wait.
A report in the New England Journal of Medicine last week said that the United States wastes huge amounts of money on medical paperwork, and if the amount were brought down to the level of the Canadian system-where there is a single insurer per province, the provincial government-the U.S. could save $100 billion a year.
In a system that spends $666 billion on health care annually, that $100 billion could make a big difference, perhaps enough to cover the millions who are uninsured, according to the budget office.
Americans might balk at the Canadian system even though it is cheaper, according to Michael Bromberg, executive director of the American Federation of Health Systems, an umbrella group representing hospitals.
”Americans are spoiled,” he said. ”We`re just not a country that puts up with queuing up for anything, let alone health care.”
Bromberg also said there are so many constituencies in health care at present that would be offended by a universal health-care system that it is virtually impossible to enact one.
”Government is not going to take a Marty Russo approach,” he said, but added that his proposal is ”a catalyst” for change.