Federal Health Care Reform: Climbing the Bipartisan List

At the beginning of his first term, President Clinton was pilloried for his ideas on overhauling health care. By the end of it, Republicans were being stung in the polls for proposing limits on Medicare spending.

You’d think the issue would be the hottest of political potatoes now. But surprisingly health care reform has become a top priority for both parties, and there is strong bipartisan agreement on at least one principle: Managed care is the best way to rein in spiraling federal spending for Medicare, which covers the elderly and disabled, and for Medicaid, which covers many of the poor.

There is, however, one problem. The Health Care Financing Administration, the federal agency responsible for running Medicare and Medicaid, has no satisfactory method of assessing HMOs’ performance or enforcing minimum health care standards. So if Washington intends to be prudent in its relationship with managed care organizations, it should promptly take two steps:

* The agency must establish a minimum quality-of-care standard so patients will not suffer under the inevitable spending cuts--such as President Clinton’s recent proposal to trim $22 billion in Medicaid spending in the coming fiscal year and $138 billion in Medicare spending over six years. If the agency does not promptly overhaul its assessment standards, spending cuts might come at the expense of HIV-positive patients and others arbitrarily denied care.

As policy analyst Robert H. Brook of the Rand Corp. explained in a recent Washington hearing, “The challenge for the next four years is, will we pay anything but lip service attention to quality? . . . We have to define what we mean by necessary care. . . . Unless the clinical science of medicine is part of the reform process, all they’re going to do is cut costs or change the distribution of who gets money.”

* Medicare and Medicaid should be expanded to cover preventive health care services like diabetes management and tests to provide early diagnosis of cancers of the breast, cervix, colon and prostate. Such care may require short-term federal spending, but it will both ultimately reduce costs and lengthen lives.

Medicaid and Medicare reforms alone will not solve all of America’s pressing health care problems. For instance, tens of millions of Americans make too much money to qualify for Medicaid but too little to afford their own insurance. Congressional Democrats have proposed federal tax credits and vouchers to help low-income working families buy insurance, and Clinton is expected to propose something similar in his State of the Union address Tuesday.

The problem of the uninsured is especially acute in California, and Los Angeles has the state’s highest rate of residents without health insurance; one-third of non-elderly L.A. residents are not covered.

Legislators in Sacramento are drafting a bevy of bills to provide access to health coverage for the working poor and their children, and there is bipartisan agreement on the need for change. The budget that Gov. Pete Wilson proposed earlier this month, for instance, underscores the importance of “expanding access to essential services for California’s most vulnerable populations.” Now is the time to turn these common principles into policy.