Newspaper article St Louis Post-Dispatch (MO)

A Solution to Puzzle of Health Care

Newspaper article St Louis Post-Dispatch (MO)

A Solution to Puzzle of Health Care

Article excerpt

The Clinton administration, Congress, the media and the public are suffering a massive case of amnesia. All have forgotten that, to a great extent, the health-care debate is about the economy. Reducing the cost of health care is a necessity for the budgets of individuals, families, business, the federal government and the states. Without it, universal coverage remains unaffordable.

During the 1992 campaign, candidate Bill Clinton analyzed the problem realistically: More than 37 million people lack assured health care from either private or public programs. Even so, many of them receive medical services - often provided late and at great expense in emergency rooms. Hospitals and other providers shift those high costs to Medicare, Medicaid and to patients with insurance, boosting rates. Thus, most of us pay for the uninsured through increased insurance rates, higher Medicare premiums and taxes for the greater outlays of the federal and state governments. Candidate Clinton also explained that ballooning health-care costs hamper the ability of American business to compete. And that means jobs. We all understood that during the campaign.

Unfortunately, the connection between costs and coverage was not so vividly explained. But it exists. To cover all of the uncovered and to provide coverage for pre-existing conditions will cost tens of billions of dollars.

Since the public has zero tolerance for new taxes and additional outlays, we can achieve the desired goals primarily by saving vast sums of money through changes in the organization of medical insurance.

The Clinton plan assigned the task of saving money to regional "health alliances," now sometimes called "co-ops." According to the prospectus, their know-how and bargaining power would select a few insurers and providers with better packages and lower cost than the companies could get for themselves. But these savings would come slowly and require phasing in coverage over many years.

Health alliances didn't sell. The fictional "Harry and Louise" painted them as bureaucratic monsters, government in disguise. Meanwhile, the National Federation of Independent Business howled that mandated coverage (requiring employers to pay 80 percent of premium costs) would kill off small businesses, even though the Clinton plan offered contribution caps and subsidies for small business.

But if we seek affordable cost for small business that way, the cost for everyone else must go up or the benefit package must shrink. It would be far better to keep down everyone's costs and thereby make assured medical care more affordable for businesses, families, the federal government and the states, not least because Medicare and Medicaid constitute the fastest growing portion of both state and federal budgets. If you think that's bad, consider this: Administrative costs for private health insurance ran to 17 percent of benefits in 1992, compared with 2. …

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