Carefully Into the Breach : Best Rx for health care reform? Slow, but keep going forward steadily

Semantic squabbles over whether the U.S. system of health care is in “crisis” miss the point. It’s no secret that the nation’s system is not what it should be and that Americans pay a terrible price for its shortcomings.

At long last, lawmakers are beginning to focus on what most have known for a long time: This nation’s health care system works well for only a steadily shrinking number of Americans. Physicians and nurses see horrific inadequacies in how the system rations care. They see emergency room patients waiting for treatment for a once minor ailment that has become a costly, life-threatening illness because the patient could not afford to get treatment earlier. Insurers see millions of dollars in fraud each year perpetrated by unscrupulous physicians, lawyers, patients.

Patients want to receive the best possible treatment; but what if a state-of-the-art test costs $1,500? Who pays?

Already the average American who is insured finds he or she is paying more and has less freedom in choosing a doctor. And those are the lucky ones; 37 million have no health insurance at all. To bring it full circle, it’s the uninsured who typically crowd hospital emergency rooms seeking what should have been routine care. Who gets the bill? Everybody.

Politicians hear the public roar for change, but every step in that direction is met with fierce opposition from one or another of the many competing special interests. That is why as lawmakers review the health care reform options they must resist the temptation for quick or easy fixes. In health reform, if the fixes are quick they’re dangerous and if they’re too easy they’re not real.

However, there are good starting points on which many lawmakers already agree: cracking down on fraud and excessive paperwork; prohibiting the unfair practice by insurers of denying coverage based on pre-existing medical conditions; establishing purchasing pools that would give individuals and small businesses greater clout to negotiate rates with insurers; promoting a package of benefits that covers preventive services, such as childhood immunizations or Pap smears.

The financing and cost-control elements of health care reform clearly are those with the greatest chance of causing unintended consequences. For example, would President Clinton’s plan to require employers to provide employee coverage encourage companies to contract out more jobs? Would limits on federal tax deductions allowed for employers encourage them to dump insurance coverage for their workers?

As Congress studies options for health care reform, the unintended consequences must be carefully explored. As one analyst aptly put it, “It is things like this that make me a gradualist when it comes to public policy.”