The death of true reform measures What happened to the great health care debate? by Dan Fanaras

Much of the debate over health care reform has subsided over the past few years, replaced by talk of the problems of Medicare and Medicaid. This issue, which almost became disastrous for President Clinton during his first two years in office, seems to have left most political arenas. Major bipartisan political discussion is now limited to either balancing the federal budget or campaign finance reform. Once a big issue, the health care reform debate is now reduced to an occasional article in the New York Times about the solvency of the Medicare program. One must question why this debate has disappeared. A study by the Organization for Economic Cooperation and Development concluded that the United States spends much more per capita on health care than most other developed nations. For example, we spend nearly 258 percent more per capita than Ireland, 182 percent more than the United Kingdom, and 91 percent more than Germany. These comparisons were made by using the percentage of each nation's Gross Domestic Product (GDP) spent on health care. The U.S. currently spends approximately 12 percent of its GDP on health care, and this figure has been estimated to reach nearly 33 percent by the year 2030. In some ways, our nation benefits from having a large health care industry. American medicine is superior in many ways to that available in the rest of the world, with innovative treatments and surgical procedures that aren't found elsewhere available to those who can pay. Yet with nearly 41 million uninsured people counted in 1994, adequate health care is only being provided to those who can afford it. However, simply being uninsured doesn't mean being incapable of affording health coverage. Workers without access to medical benefits from their jobs sometimes choose not to seek coverage independently, despite being financially able to do so. Still, most Americans who are working without health benefits cannot afford to purchase them on their own. While many Americans lack any sort of health coverage, many who do have insurance remain under-insured and lacking adequate coverage. This is more common as most health plans move towards managed care, such as HMOs, which attempt to lower the costs of providing health care to enrollees. Unfortunately, much of the streamlining boils down to refusing to cover many treatments and procedures as well as refusing to provide insurance coverage for pre-existing conditions. As a result, each year fewer people have access to adequate health coverage- only those who can afford comprehensive coverage are entitled to it. During 1993, President Clinton attempted to remedy this somewhat, rightfully proposing reforms that included requiring all employers to cover their employees and streamlining administrative costs and paper work. But his plan lacked major reforms such as expanding health coverage and regulating costs in the private health care sector. Some argued that the private sector could generate its own cost reductions, but cuts accepted by physicians served only to increase insurance company profits, not to lower premiums. While liberals focused on providing adequate coverage to all Americans, the primary goal for conservatives during the health care reform debate was cost containment. The evidence of slowed growth in the private sector was the fuel conservatives needed to shift the health care debate towards reforming Medicare. While Medicare reform is an important topic which certainly needs bipartisan action to maintain its solvency, it shouldn't constitute the entire issue of health care reform. Still, even with so many Americans suffering from a lack of coverage, the health care debate has seemingly come to an end. One reason is that, during 1993-1994, at the same time policy makers were calling for reform, health care expenditures increased by only about 6%, the smallest increase in three decades. Apparently, all the talk of reform actually had an impact on the industry, as health care providers contained their own costs out of fear of reform. Is it on your side?   However, the evidence of slowed growth may have misguided a number of policy makers into calling off the effort for reform. Although the numbers indicate a decrease in the growth of health expenditures, the actual growth rate still remained much higher than the rate of inflation during that time. This means that the industry was still expanding much more than necessary, through a combination of increased output and higher prices. Also, the slowed growth between 1993 and 1994 was limited to expenditures in the private sector by private insurance carriers. On the other hand, government spending on Medicare increased by nearly twelve percent, which was almost three times the growth of private health insurance spending. This fact seemingly transformed the entire health care reform debate into a much more specific one about reforming the Medicare system. Indeed, Medicare was and continues to be a pressing issue. However, it seems that the policy makers completely abandoned the idea of reforming the entire system. Nearly 41 million Americans were still without health insurance and millions more lacked adequate coverage, but Washington turned its back. We clearly need a more socialist health care system to extend health benefits to more Americans and it seems that we've missed our chance. But was the chance even there? During the debate, policy makers realized the importance of the health care industry, and both liberals and conservatives chose not to disrupt our economy by restructuring it. As a result, Washington is left with an occasional dialogue about Medicare reform and the American people are left with inadequate health coverage.

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