Our Health Care Is Sick

Vigorous new efforts to make the health-care system universal are under way at the national level and in California as well. The concern and effort come at an appropriate time. President-elect George Bush has a commitment to filling the gaps in the existing system. And the American people, in poll after poll, have shown their conviction that basic health care is a right of every citizen.

At the moment there is agreement only on the problem’s dimensions. At least 35 million Americans are without any form of health insurance. Despite its glaring failures, the American health-care system is the most expensive in the world. The United States is the only industrialized democracy without universal health insurance.

There are good reasons for a fresh start at this time:

--The cost of health care is continuing to escalate at close to double the rate of inflation.

--The inequity of the present system has been dramatized by new studies showing that millions of children are among those without insurance, that the United States has the highest infant-mortality rate of all Western nations.

Foremost among the studies under way is that of the National Leadership Commission on Health Care. Its conclusions will be made public Jan. 30. The commission’s honorary co-chairmen are former Presidents Richard M. Nixon, Gerald R. Ford and Jimmy Carter. The commission includes many of the nation’s experts on health care. Their commitment has been to produce a specific plan that would engage both public and private institutions in a new strategy addressing the three critical problems: quality, access and cost containment.

In the meantime, three separate proposals for providing health care to everyone in the nation have been outlined in recent days. They reflect the thinking of experts, many of them long engaged in contriving ways to improve the system. They deserve careful study.

The most comprehensive and extensive in terms of change has been drafted by Physicians for a National Health Program, a nationwide group with headquarters at Cambridge Hospital-Harvard Medical School. Essentially it is an adaptation of the Canadian model, probably the best national health-care plan now in operation, using existing funding sources but paying for all services from a single pool while ensuring universal protection. It was presented in the current issue of the New England Journal of Medicine.

An alternative plan, also published in the New England Journal, offers more modest reforms to ensure universal care. It is the work of Alain Enthoven and Richard Kronick of the Stanford Graduate School of Business. They propose a complex strategy of so-called managed competition designed to minimize the waste, inequity and inflationary forces in the existing system.

Yet another plan was published last week in the Wall Street Journal--the work of Uwe E. Reinhardt, an economist at Princeton who is also a member of the National Leadership Commission. He would create a “fail-safe system,” financed by a combination of income and excise taxes, to provide basic protection for those not otherwise protected. He argues that this would be preferable to legislation now before Congress to mandate employer-funded health insurance for all workers.

In California the California Medical Assn. has set aside $50,000 to organize a coalition of health-care providers and other groups, including business, to develop legislation to provide universal health care. Their goal is action at the current session of the Legislature. Massachusetts enacted its own universal plan last year.

Dr. Arnold S. Relman, editor of the New England Journal, summed up the challenge with great accuracy when he wrote: “In my view, nothing short of a comprehensive plan, which includes improved technology assessment and malpractice reform as well as other reforms in medical practice, is likely to achieve the goals of universal access, cost containment and preservation of quality that everyone seems to want.”