Healthcare Options in an Election Year
Reynolds, Larry, Management Review
When it comes to reforming the nation's healthcare system, "this issue is potentially strong enough to turn goat spit into gasoline," says political consultant Paul Begala. It was also strong enough to elect Begala's client, Harris Wofford (D-Pa.), to the Senate last fall in a surprise victory over supposed shoe-in candidate Richard Thornburgh, the former U.S. Attorney General.
Playing on voter concerns over skyrocketing healthcare costs, worries about losing their jobs because of the recession, and general frustration with Washington's seeming inability to do anything about either problem, Wofford made the healthcare hook centerpiece of his campaign strategy. Television ads telling voters, "If criminals have a right to a lawyer, sick Americans should have a right to see a doctor," gave the Democrat an old-fashioned come-from-behind populist victory that hit the hot button of politicians inside the Washington Beltway, as well as working- and middle-class families in Pennsylvania's mill towns and big cities.
It's hard to find anyone who doesn't agree that "something has to be done" about the spiraling cost of healthcare and the large numbers of people who can't afford, or simply don't have, health insurance. There's no lack of opinions in Washington about what should be done. Over the past year alone, some 90 different legislative proposals to revise and revamp the nation's healthcare system have been introduced in Congress. However, a glaring lack of consensus over what to do has caused political gridlock from Capitol Hill to the White House.
There's a fair to good chance Congress will move to tackle part of the healthcare reform equation this year by opening up the medical insurance market, making health coverage more available and affordable for smaller firms. Some Democrats even are talking about an all-out push for passage of a massive reform bill which would surely be vetoed by the President as another congressional Democratic tax-and-spend, budgetbusting boondoggle--just before the fall elections.
No one doubts that George Bush and Bill Clinton will make the topic of healthcare reform a major campaign issue. But with 100 to 150 House members expected to either retire or be defeated at the polls in November, most political strategists are waiting to see what the new congressional and White House demographics will look like before making any bets on how fast a comprehensive health insurance reform package can be put together. In turn, "Despite all the campaign promises, you can pretty much ignore what both presidential contenders say this fall about healthcare, because the whole debate will be reshaped according to the makeup of a new Congress, and whatever mandate they think they received from voters," predicts Washington lobbyist John Satagaj.
"We need a major overhaul of the healthcare system," acknowledges Senator Lloyd Bentsen (D-Texas), chairman of the Senate Finance Committee. What that would be, and how to go about it, is the sticking point. Both Democrats and Republicans are divided among themselves--and with each other--over the best course of action to take. Adding to the confusion are literally hundreds of special interest and professional groups, and their political action committees, which are constantly lobbying and promoting their particular perspectives on the problem (see related story on page 14).
Details aside, most of the major healthcare reform bills under serious consideration fall into three general categories. First are the socalled play-or-pay plans promoted by the Senate leadership that expand on the current employer-based benefits system requiring that companies either provide employees with a minimum package of healthcare benefits or pay a separate payroll tax (workers also would be levied) to finance coverage for the uninsured. Varia- tions on this approach would set lim- its on medical prices and establish a ceiling on national healthcare spend- ing. …