Medical Industry, Congressmen Call for Health Care Reform

Article excerpt

By Philip J. Hilts N.Y. Times News Service WASHINGTON _ The American health care system is the most expensive in the world, but for those not in its mainstream, the care it offers is among the most unsatisfactory. Americans pay $700 billion a year for health care but 34 million of them remain uninsured. Life expectancy in the United States is shorter than in 15 other nations, and infant mortality is worse than in 22 other countries. Many believe this is a system in crisis, a crisis marked by sharp contrasts drawn mostly along class lines but permeating every segment of society. Now, after decades of fruitless debate, it has inspired a sense of urgency. In Congress, there have been more than a dozen proposals to revamp the system. And last week the medical establishment, through its leading pro- fessional publication, the Journal of the American Medical Association, trum- peted its concern and called for action. While these and other advocates have produced a bewildering diversity of overhaul plans, they agree on at least a couple of things:

Reforming health care is essentially a political problem.

It will be difficult to solve without leadership from the White House, which so far has had little to say on the issue. A main concern of reformers is that patients' medical needs play so small a role in determining levels of care and reimbursement. Ron Pollack, executive director of Families U.S.A., a non-profit health reform group, tells of a Maryland couple with full health insurance that has been bankrupted by their son's ailment. A star soccer player by day, the boy suffers near suffocation every night because of a nerve disorder. The family's policy, as most policies do, has an upper limit on some expenses, and theirs _ $100,000 per dependent _ was exceeded when the boy was 11 months old. He is now 10 years old; his family is $600,000 in debt. For the public, fear is growing. In any two-year period there are 34 million people without health insurance. But the number who lose their insurance at least temporarily is nearly double that many, 63 million. For businesses, tension is rising. Companies watch as health care spend- ing devours ever larger portions of their profits. In the 1960s, businesses spent between 4 percent and 8 percent of each dollar of profits on health care. In 1990, it was 25 percent to 50 percent and rising. For labor, anger mounts. The Service Employees International Union reports that the proportion of workers involved in health-care related strikes rose from 18 percent of all strikers in 1986 to 78 percent in 1989. Enter the doctors. Last week, the American Medical Association _ a group usually seen as fiercely opposed to all social reform in medicine _ shed its inhibitions. The Journal of the American Medical Association and all of its nine attendant journals were devoted to calls for health care reform. There were no fewer than 13 separate proposed solu- tions. The new leadership at the physicians' group made strong statements of new- found fervor for reform. "The AMA's old style was to react and be against things," said C. John Tupper, president of the association. "But there has been a philosophical change in our house of delegates (the group's policy-making body). "We will be out front where the action is. We'll stop being just selfish and only thinking of our own welfare. If we start taking good care of our patients, they will take care of us. "I think we will see health care reform high on the list of both presiden- tial candidates in the next election." But on the Potomac, when there is too much interest in a subject a political paralysis can result. In Congress there have been no fewer than 14 proposals to revamp the national system. At the White House, there have been no major proposals, as political specialists wait for the right conservative proposal and the right moment _ just before or just after the election _ to put it forward. …


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