As Congress prepares to tackle a handful of serious healthcare reform proposals, one thing is clear: there's plenty of room for compromise.
Although Washington pundits believe the momentum and political winds are right to prompt action on healthcare, that's no reason to completely revamp a sophisticated, delicate system that works well for most Americans. Moreover, there's something unsettling about turning over more control of a $1 trillion industry to the federal government.
That's not to say the system doesn't need a major tune-up. Universal access and cost containment certainly are virtuous goals that deserve attention. But instead of Bill Clinton's fuzzy, untested model of managed competition, Congress would be better off concentrating on a few improvements in 1994 and using them as building blocks to reform the system.
To accomplish nothing on the legislative front this year would be shameful. The recent Commerce Department prognostication that 1994 healthcare spending will shatter the trillion-dollar barrier is a sobering reminder of the matter's urgency. However, the very size and staggering growth of healthcare spending is reason enough to proceed with caution. Healthcare will control about 15% of the nation's gross domestic product in 1994, up from 14% in 1993 and 13% in 1992. The industry is creating jobs, stimulating capital expansion and extending the health and longevity of millions of Americans.
A shock to the healthcare system, such as the Clinton plan, could prove catastrophic to the U.S. economy at a time when the nation is slowly recovering from its recessionary malaise. If local providers can continue to trim spending, form intelligent delivery networks and plan services with community benefits in mind, there will be less need for dictates from Washington.
However, the Clinton administration and Congress can help set some sensible national policies to help push the process along. These improvements should be meaningful and not just window dressing to help politicians get re-elected in November.
Some shining stars to shoot for include:
|A workplace-based system that forces employers to offer a pre-defined set of medical benefits or contribute to a public insurance fund. The priority should be to ensure that all Americans have access to healthcare coverage.
|A community-rating system that prevents insurers from turning away individuals because of their past medical histories. Guaranteeing insurance portability for those who lose or change jobs is another area that needs to be addressed.
|Administrative simplicity so that healthcare bills are easier to understand and paid more promptly.
|Increasing the pool of primary-care physicians by providing incentives for students and medical schools. In addition, wider authority to treat patients should be given to nurse midwives, nurse practitioners and clinical nurse specialists.
President Clinton has talked about compromise for months. He hasn't even seemed concerned that much of the momentum of the administration's proposal has been lost to Republicans and moderate and conservative Democrats. We hope this statesmanlike approach continues when it becomes clear that incremental improvements make more sense for America in 1994.