Outshout the Drug Lobby

The double-digit rise in health-care premiums in each of the last four years was the key reason three supermarket chains and some government agencies this year decided to begin paring their workers’ health benefits, prompting recent union walkouts.

It doesn’t take a calculus major to see that something’s wrong with the economics of the nation’s health-care system. The United States spends $1.6 trillion a year on health care, far more per person than any other nation, and yet still fails to insure 43 million of its citizens. That’s more people than live in 24 states and the District of Columbia.

And yet, Congress and the Bush administration, far from moving to contain costs, are focusing all their health-care attention on a reform sure to send them soaring even higher: a $400-billion-plus prescription drug benefit that would provide dubious benefits for most seniors but definite profits for drug companies, whose team of lobbyists in Washington (more than 600) exceeds the number of legislators in Congress.

Last week, retired Gen. Wesley K. Clark called for a federal commission to rein in soaring premiums through “diagnostic and prevention services.” But like most other Democratic presidential candidates, Clark avoids talking about politically unpopular reforms such as rationing, which divides treatments into those that are medically necessary, those that might help and those that shouldn’t be part of a basic plan.

Clark’s proposal to spend about $122 billion a year covering 32 million Americans aims to improve, not overhaul, the present system -- a modest goal similar to that of his main political competitors. Clark may be right that the only health legislation that can pass Congress will steer a middle course. But he and the others should at least propose concrete ways to reach the larger goal of providing health care to all, not just some, Americans.

There are ways to attain universal health coverage without putting Washington in charge. Late last year, for instance, Bruce Bodaken, who heads Blue Shield of California, released a “universal coverage, universal responsibility” plan to build on the employer-sponsored system by making health insurance mandatory. Its key goal is to prevent insurers from “cherry-picking,” the industry practice of offering cheap policies to the young and healthy while sticking everyone else with stratospheric prices. There are plenty of other good ideas -- going back to the health-care reform debate of 1993 -- that are worth digging up for discussion, revision and action.

Universal health care won’t have even a fleeting chance until Americans start speaking as loudly as those 600 free-spending drug lobbyists. Americans must connect the picket lines of workers striking over benefits to the soaring health insurance premiums to the difficulty of securing doctors’ appointments: They are the results of Washington’s refusal to deal with comprehensive health-care reform. Congress, the president and the candidates who would like to replace him should feel relentless, unbearable political heat until they do deal with it.