There is no free lunch on the healthcare reform menu.
Reforms are proving so costly, burdensome and overly ambitious that many states are curtailing their efforts. Their actions should prompt President Clinton and Congress to take stock of the staggering responsibility of widening access to the healthcare system while at the same time promising lower costs.
The latest poppycock comes from HHS, which says states would save an estimated $43 billion in Medicaid spending over five years if President Clinton's healthcare reform plan was passed unaltered.
But reform can't be accomplished without a lot of pain, sacrifice, money and political courage. That's scaring officials in some of the states that have exhibited the strongest consensus for reform, and they're backing off. For example:
In Florida, the state medical association and Blue Cross and Blue Shield are asking Gov. Lawton Chiles not to expand the managed competition system. There's concern that the state doesn't have the money to adequately administer the program.
Tennessee hastily implemented a TennCare Medicaid reform package that has left patients baffled and providers grumbling about reimbursement shortfalls.
The momentum for incremental changes in Colorado has overtaken the ambitious ColoradoCare program developed by Gov. Roy Romer.
Minnesota health officials are urging a three-year delay in the state's effort to provide universal insurance through integrated service networks. Cost and coverage confusion were cited by those who must administer the landmark MinnesotaCare program.
Political leaders in Maine have shelved comprehensive reform efforts in favor of synchronizing their policy with efforts crafted by the federal government.
Ironically, the more a state implements reforms, the more it seems to add to its Medicaid bill. Thus, it's no surprise that cash-starved states are turning to Uncle Sam in Washington to solve the Medicaid mess. We can hear the cries:
Take the monkey off our back, President Bill.
Build us a framework for reform, Rep. Rosty.
Cure our financing woes, Secretary Shalala.
Without federally guaranteed health insurance, states will contend that they can't afford to increase spending on crime prevention, education and other social programs.
Consider these tidbits provided by the Democratic National Committee: Medicaid costs have climbed 440% since 1980, and the program now absorbs 17% of state budgets. In 1993, for the first time, states spent more money on Medicaid than they did on tax-financed higher education. State Medicaid spending could triple between 1990 and 1995.
A word to the wise. In the end, hospitals andphysicians-not government-will assume the financial risk of treating all patients. Providers and insurers will make the tough calls on rationing care, not public officials. That's the direction healthcare reform is taking.