Solutions Lacking as Health Costs Climb

Problems plaguing the nation’s health care system are bringing Democrats and Republicans, physicians and consumer advocates together on at least one point: Change is needed.

But what those changes should be could keep them arguing for a long time to come.

Meanwhile, America’s health care bill keeps mounting. This year, medical expenditures are expected to exceed $600 billion--nearly 12% of the nation’s gross national product--while as many as 37 million people go without any sort of medical insurance coverage.

“We’re on an unsustainable path,” said Jack Meyer, a Washington health policy consultant.

But he and other analysts say that with many in Congress averse to new spending and lawmakers still stinging from last year’s repeal of the Medicare insurance program for catastrophic illness, major changes in the health system are not imminent.

“The voting public is not yet exercised about this for it to be a major political issue, but that’s changing,” said Lynn Etheredge, a health policy consultant based in Chevy Chase, Md.

Businesses, hit by rising health-care premiums, are passing along more of the costs to their workers and pulling back some of the benefits. Health care benefits have been the central issue in a growing number of labor strikes.

“The average American worker . . . is unaware of the magnitude of the cost” of health-care benefits, said William Ferguson, chairman of the board of Nynex Corp., where workers last year staged a four-month strike in which health coverage was a main issue.

“But they are starting to wake up. Workers are beginning to understand that rising health costs are putting a dent in their pay raises,” he said at a recent gathering of health care providers.

In early March, the bipartisan Pepper Commission, which included leaders of tax and health-care committees in Congress, completed a yearlong study with a proposal to provide health-care coverage and long-term care for all Americans.

However, the heath-care part of the plan was approved by only a one-vote margin and the package was immediately criticized because it did not recommend a way to pay the estimated $66-billion federal price tag.

Many of the various players in the existing health care system--including insurance companies, physicians, unions and corporations--have come up with their own proposals.

And new groups and coalitions are still forming around the issue. In March, 35 major corporations, unions, consumer groups and other private organizations formed the National Leadership Coalition for Health Care Reform. It’s the first attempt by big business and labor to join in drafting a plan.

Of the proposals that have been put forth so far, only a few advocate a government-run health system or go to the other extreme with a purely private approach. Most fall into a middle ground that, like the Pepper Commission, calls for a public-private sharing of the burden.

Most of the plans would build on the existing system of employer-provided health insurance --85% of Americans are covered in this way now--with various incentives or mandates for business to include more workers in these programs. Some would create risk pools to make affordable policies available to those who because of chronic disease couldn’t otherwise afford insurance. And the government would have responsibility for taking care of the rest.

Most policy analysts and health-care consultants say this middle-ground approach is the only one that is politically possible, but even then it’s not a sure bet.

“We will address a national health plan when the President makes it an issue for his Administration,” said Henry Aaron, a senior fellow at the Brookings Institution, a liberal think tank in Washington.

“The Administration will move when it feels there’s a good political opportunity,” he said. “And the key for any Administration will be further crumbling of business opposition to government involvement.”

He doubts that the public will rise up in protest and demand solutions to the deficiencies in the current system.

“Any time 85% of the population is insured and receives the best medical care in the world--it may be a little too expensive but so are automobiles, and people will grouse about that--they’re not going to grouse enough to make it a salient political issue,” he said.