In 1986, I moved from New York to join the Washington bureau of MODERN HEALTHCARE. At the time, national healthcare spending was $454 billion, Democrats had recaptured the Senate, and HHS Secretary Otis Bowen, M.D., was preparing a plan to expand Medicare coverage to catastrophic medical expenses.
Obviously, a lot's happened since then. A healthcare crisis has mushroomed, with the annual tab for services now approaching $1 trillion and uninsured Americans estimated at 35 million.
Potential solutions to these problems have become larger and more complex. Since costs can't be contained without filling coverage gaps, and vice versa, lawmakers must overcome deep ideological differences to produce a bill that addresses problems simultaneously.
This year, we've seen how difficult it's going to be for Congress to craft a comprehensive plan. The ugliness of an election year has compounded the barriers to major healthcare reform legislation.
It's also been difficult for interest groups to approach reform with the united spirit of acting for the greatest good.
And much of the media coverage has focused on the politics of reform, while so-called educational efforts by interest groups have been skewed to fit their own agendas. Harry and Louise, stars of the Health Insurance Association of America's television campaign against the Clinton health plan, may be the best-known purveyors of reform information.
Yet, there are far more reasons to hope than despair about the prospect for meaningful health reform. First, one need only look at history to see that reform has been a work in progress for decades, starting with the emergence of Blue Cross and Blue Shield, then Medicare and Medicaid, followed by 30 years of changes to federal and state programs. Reforms of the past have been incremental in tackling problems. But they've also been comprehensive in addressing discrete issues.
In the most recent wave of reform mania, few proposals-and none that have received serious attention-rest on a middle ground between a full-scale, overly complex overhaul of the healthcare system and a bare-bones, survival-of-the-fittest approach.
Successful present-day reforms likely will strike that elusive middle ground, even if it means going back year after year to add to, subtract from and alter existing policy.
Much attention has been given to the 1994 "window of opportunity" for reform. And it's true there is great political momentum now for a major reform bill. But far too much has been made of predictions that if reform isn't enacted this year, it won't seriously be revisited for the rest of the century.
I've always believed the conscience of a nation is, to a great extent, reflected in its healthcare system. I'm confident that eventually Americans will do the right thing, though that might come, as Winston Churchill once said, only after we've tried everything else.
Washington Bureau Chief Lynn Wagner is leaving MODERN HEALTHCARE to become a healthcare reports analyst at the General Accounting Office.