Splintering of Health Groups and Budget Cuts

After reading Martin Shapiro's account of how health budget cuts hurt real people (Editorial Pages, March 25), "Health-Care Research Indicates Reagan Is Wrong--Fund Cuts Will Hurt," one must ask why the patient has been replaced by budget constraints as the centerpiece of U.S. health policy.

The $200-billion federal deficit is only one explanation. An equally important reason is the splintering of the health-care community--consumer groups, doctors, nurses, hospitals, suppliers--into narrow special interests that have permitted the Reagan budgeteers easy access to Medicare slashing.

Public, voluntary, and for-profit hospitals now have distinct, often conflicting, agendas. Surgeons and internists disagree over how they should be paid. Providers and consumer groups--including the elderly--have historically suspected each others motives. So in the major budget battles, forces that should work in unison on behalf of quality and access too often guard only their own self-interest.

Consequently, in the budgetary tournament, a field of health baronies has been conquered by an elite federal corps organized around a single principle: "Cut the budget." That has resulted in more than $30 billion in Medicare cuts just since 1981. And health care is the hardest-hit program area in the Reagan budget for 1987 and beyond. For example, Medicare would suffer $4.7 billion in deficit reductions under the President's 1987 budget, while defense would be cut by only $2.7 billion.

The only way to turn that around is for health-care groups to abandon their outmoded battle lines and call, in unison, for replacing the debate over budget cuts with a reasoned offensive for the value, safety and fairness of health care. They must call for cost constraint that is balanced with prudent, creative solutions to deteriorating quality and access, uncompensated care, and inadequate coverage for both catastrophic and long-term care. And, above all, each group must recognize that the patient, not petty self-interest, is the fundamental, motivating principle.

Without cohesion and unity of effort on this central point, the budget cuts will never stop. And little by little, each of us will surely suffer.



Samuel is president of the Health Industry Manufacturers Assn.

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