The Clinton administration and friends of healthcare reform finally are starting to face economic reality. As Rep. Dan Rostenkowski (D-Ill.) told the Harvard School of Public Health, "We still haven't found the healthcare fairy and we're not terribly optimistic that we will."
Translation: It may take tens of billions of new (tax) dollars to guarantee that all Americans have health coverage and to fix other flaws in the healthcare system. The admission by Mr. Rostenkowski, who chairs the House Ways and Means Committee, is a welcome break from the fantasy that has dominated much of the political rhetoric about reform.
After all, it was only a few months ago that President Clinton unveiled his healthcare plan by saying it would result in a $58 billion deficit reduction over five years. That was pure baloney and helped create an instant credibility gap that has imperiled his entire reform proposal.
After countless studies, expert testimony and deadlocked committee votes, Senate Majority Leader George Mitchell (D-Maine) was forced to tell his troops they should consider less costly options designed to attract broader support. The real debate will begin once the politicians acknowledge that instead of getting more healthcare for less money, health reform and universal access could well mean less healthcare for more money.
Reform advocates say millions of dollars have been spent by opponents to protect the status quo by raising public fears about change. That's true, but the blitz has been successful mainly because the president and supporters of reform have been so vulnerable.
Pragmatic talk from the likes of Messrs. Mitchell and Rostenkowski could help clear the smokescreen of disinformation. Hospital lobbyists for the most part have been supporters or only minor critics of the president's plan. For example, the four major hospital alliances-VHA, SunHealth, Premier and AmHS-recently joined forces to endorse six major principles of healthcare reform.
We encourage providers to keep supporting a program that advocates universal access, managed competition, preventive care, initiatives to promote healthy lifestyles, minimal government control over healthcare delivery and greater personal responsibility.
True healthcare reform will only be achieved once it becomes a communitywide project. Individuals may have to pay more and take more responsibility for their health. Physicians may earn less money and spend more time on general, rather than specialized, medicine. Some hospitals may close or merge with competitors. All businesses may be forced to pay some of the cost of their employees' insurance. Many insurance companies may leave the health business, while the survivors may assume more risk.
It's called sacrifice, and if the government wants a bigger role, elected officials must be prepared to pay the piper. Instead of debating how much can be saved from lower Medicare payments to providers, Congress needs to discuss the painful possibility of taxing healthcare benefits or other broad-based levies. If the American public and politicians are truly interested in healthcare reform, they'll grudgingly consider such harsh measures.
Until negotiations become serious, providers should look for more ways to achieve community health harmony. One interesting example is Working Well Together, a personal responsibility campaign in Connecticut coordinated by a physician-owned HMO, the media, the state department of public health and 29 hospitals. As a recent study by the Healthcare Forum showed, healthcare providers can help elevate the reform debate by addressing issues such as family concerns, the environment and personal responsibility for healthier lifestyles.