Clinton May Boost Health Care Efficiency

Beyond even jobs and the economy, the gut-wrenching question for most people is: Can the Clinton Administration bring order to the chaos in the nation’s health care system?

That question took on heightened meaning Monday after the U.S. Supreme Court’s decision that an employee’s health coverage can be cut abruptly when he or she contracts a chronic disease.

The court let stand rulings in favor of a small employer who slashed coverage for an employee who had AIDS--and thereby sent an ominous message to sufferers of AIDS, cancer, Alzheimer’s, heart disease and other long-term illnesses.

In his campaign, Clinton promised health insurance to every American--and strengthened coverage for long-term illness.

The election is over, Clinton’s advisers are tight-lipped about their plans, and companies are nervous. Corporations such as Unisys and McDonnell Douglas said recently that, because of ballooning liability, they will reduce or eliminate health insurance for retirees.

The system is in disarray, and Clinton will have to speak up soon.

Meanwhile, it’s not hard to discern the outlines of policies and realities for the years ahead from what is being said in Little Rock and Washington.

The first move will be to cut what hospitals and doctors can charge Medicare--on the theory that such government action will reduce a hospital’s billings across the board. “That will be easy to pass in Congress,” says John Hermann, editor of Health Systems Review, a hospital-backed publication. “The hospitals are already resigned to more caps and controls.”

But there will also be sharp limits on experimental medicine--or new ways devised to pay for it, predicts Glenn Meister of Foster Higgins, an employee benefits consulting firm. That’s where real debate will come in--first because many advanced treatments of cancer, AIDS and heart trouble are by nature experimental.

Also, Americans want advanced care. There are about 1,300 magnetic resonance imaging machines in the United States, and a proportionately large number in Japan. But there are only a dozen or so in Canada or Germany and two dozen in Britain, the nations that Clinton advisers are studying as models for national health plans.

An MRI scan is an intelligent, non-invasive treatment--safer and less expensive than exploratory surgery. But at $1,200 a scan, it is not cheap. So there will be arguments over frequent use of the procedure and over who pays. Employers increasingly will demand that employees pay more of the insurance premiums, and the medical costs. Government may tax medical benefits as ordinary income.

And though attempts will be made to provide health care to all, there will be rationing of some procedures by making patients wait--as in Canada and other countries, where patients wait two years for non-critical surgeries.

Small businesses--companies with fewer than 50 employees--will be encouraged to band together to purchase group insurance at a lower rate. “In fact, many small businesses will be covered without a formal rate, as automobile drivers are covered in an assigned risk pool,” says Ethan Kra of the William Mercer management consulting firm.

Assigned risk coverage can be expensive, and businesses--such as some fast-food restaurants--will be paying health insurance for the first time. The added cost will mean fewer fast-food restaurants--”and maybe a healthier diet,” remarks one wag. But gasoline stations and convenience stores will also close their doors.

“Health care should be a right, not a privilege,” Clinton said in the campaign. It’s a noble sentiment and a useful one, if his advisers understand that the task is to make health care affordable.

What people worry about most is not the $40 visit to the doctor, but the catastrophic illness with long-term disability that might send the family, in the phrase of the 1930s, “over the hills to the poorhouse.”

That’s why the Supreme Court decision in the case of a Houston man with AIDS, whose employer reduced maximum coverage from $1 million to $5,000, struck a chord. Many Americans have seen the medical bills that accompany cancer treatment, many families know the long and expensive sadness of caring for a relative with Alzheimer’s.

What is needed to bring those families peace of mind is not more spending on health care--the United States already spends $800 billion a year, almost three defense budgets--but more tough decisions. “With a tough cost-control program, taxes should not be necessary” to reform the system, Atul Gewande, a Clinton health care adviser, has said.

There is waste in the system and charges higher than they need to be. Proof is that Canadians, forced to wait for treatment in their own country, are coming to the United States to be treated at lower, Canadian rates by hospitals with surplus capacity.

Beyond curbing waste, there are ways to use the system better: To allocate care through local health boards, as the Clinton program proposes to do, rather than have high-tech hospital emergency rooms treating children’s sore throats.

What should lie ahead for health care is greater efficiency. “We spend more on telephones and computers than any other country, but we don’t complain because those things enhance our productivity,” says Richard Kronick, a health care expert at UC San Diego. “Good medical care, without wasteful spending, will do the same for our society.”