In his 1994 State of the Union address, President Clinton left the clear impression the administration remains committed to a government-led managed-competition model that features universal coverage and spending caps.
Although the president preaches compromise on the issue, it seems that his wife and others who helped craft the 1,342-page Health Security Act will staunchly defend the plan. But even some stalwart Democrats, such as Senate Finance Committee Chairman Daniel Patrick Moynihan of New York, believe the alleged healthcare crisis is overblown.
Nonsense, counters Mr. Clinton. "I know there are people here who say there is no healthcare crisis," he told Congress. "Tell it to the 58 million Americans" who don't have insurance coverage at some time during the year. Where does he get his numbers?
We agree that the healthcare system can be improved and that Mr. Clinton has pinpointed some of the major flaws. Cherry-picking by insurance companies, the need for insurance portability, the acute shortage of primary-care physicians and mind-boggling billing procedures require congressional attention. But to turn over direction, oversight and much of the financial management of a trillion-dollar system to government workers and appointees is imprudent. Washington, after all, has a tough time coping with a cold snap and a few snowflakes. Why should healthcare providers and patients be comfortable with a new system created by Washington's leading social engineers?
Instead of overhauling the present system, the president should stick with what he does best-preaching, leading and motivating. His speech last fall to Congress heralding the months of diligent study by Hillary Rodham Clinton's task force was inspiring. And the administration's commitment, hard work and persistence has made a difference. Providers are making progress in eliminating waste and integrating their services. Physicians are thinking twice before ordering tests that might not serve the needs of the patient. Payers are becoming more effective at buying and coordinating care. The result is a marked slowdown in the growth of healthcare inflation. That trend can continue with sustained effort by providers and bold leadership by politicians.
We also are reminded of the president's stirring statements on personal responsibility and societal burdens made last year to physicians at Johns Hopkins in Baltimore. Much of the "excess" spending on healthcare is attributable to smoking, substance abuse, crime, violence and teen-age pregnancy. The president recognizes this, but sadly none of these problems is confronted in the Health Security Act. For instance, why can't the Clinton plan recognize the merits of incentives for healthy lifestyles?
The president is right in pressing for universal insurance and phased-in employer mandates, even though the federal budget can hardly afford to carry another entitlement program. But taxing insurance benefits makes more sense than implementing an overly ambitious, untested managed-competition model.
The president's State of the Union address marks a new chapter in the saga of healthcare reform. Mr. Clinton's tumultuous first year in office featured rhetoric and agonizing study of the issue. This year is the time for lobbying, education, compromise and action. The best path for success hinges on Congress focusing on the flaws that can be fixed and the administration applying pressure, guidance and encouragement.
If providers hope to escape the burden of a federally imposed managed-competition system, it is their responsibility to organize and economize. Value and accountability must be the sacred watchwords of hospitals and physicians. Meanwhile, providers and political leaders must convince the public that medical insurance is only a right if people take responsibility for managing their own healthcare.