Critical lessons from the health reform front - health care reform - Editorial

Washington Monthly, March, 1994

Deep in one of the two most prominent health are plans in Washington, there is a single clause which dramatizes what's terribly wrong with the debate over how the country will reform its $1 trillion medical system. The Clinton administration' s bill and its chief Democratic rival, sponsored by Tennessee Rep. Jim Cooper, both allow states to experiment with their health care any way they choose--try some of Clinton, a little of Cooper, a dash of Chafee. But the Cooper plan (the one which seems to be picking up steam) makes an enormous, mind-boggling exception: States cannot---cannot--experiment with a singlepayer plan like the one now operating in Canada.

What is so frightening to Washington policy makers about even discussing how the Canadian plan might be a model for the American health care renovation? Could it be that the political culture, constrained as it is by fear of reform that would mean the near-abolition of the health insurance industry, is afraid people might like single payer if they saw it at work here?

We think that is a strong possibility. The press feeds this aversion to reform, too. For example, although stories of universal, cost-controlled systems which are experiencing even slight problems regularly win front-page display, good news about major health reform is buffed. When the 60'000'member American College of Surgeons (whose members' median income is $244,600 and who have the most to lose personally if reform passes and fees are capped) unexpectedly endorsed single payer in February, arguing it would preserve a patient's right to choose his doctor, cut bureaucracy more than any other proposal, and allow doctors to make their own medical decisions, The New York Times ran the story on page A24. The Washington Post published it on page A8.

Right now, Washington is engaged in one of its classic tribal dances, spinning and counter-spinning while the country awaits action. In fact, the clever thing to say in the capital this season was that there is no health care crisis in America. What began as a Republican strategy was picked up in January by Daniel Patrick Moynihan, who struck the pose on NBC's "Meet the Press." This counterintuitive line sounds wise, above the masses: We've done some checking, and it turns out all you deluded people worried about your insurance or paying your bills are all wrong. Not coincidentally, it also absolves lawmakers from making tough decisions and saves journalists from having to master a complicated issue.

But the "no-crisis" stance is dangerously wrong. Consider that the U.S. annually spends an astonishing 14 percent of GDP on health care while other advanced nations spend 10 percent or less. Spending billions more, we still leave 15 percent of the population--37 million Americans without insurance, millions more underinsured, and yet more millions in fear of losing coverage.

The Clintons deserve generous credit for taking on health reform. While we have grave objections to the administration's plan, we do not believe the Clintons deserve the battering they have taken for trying to produce universal coverage. In January, for example, a New Republic cover story entitled "No Exit" by Elizabeth McCaughey eviscerated the Clinton plan and did a hit-and-run on Canada but failed to offer an alternative that would provide universal coverage, saying only "Congress also should consider ways to provide insurance for those who cannot afford it... "In the issue which followed the article's publication, Michael Kinsley called it a "screed," and Ted Marmor and Jerry Mashaw, two Yale professors, wrote "virtually none of [McCaughey's] stark claims is indisputably correct." Yet the damage was done; the piece joined the Republicans and Moynihan in bombarding an administration that is at least trying to solve problems that rival plans ignore. Cooper, for instance, merely guarantees "universal access" to coverage--which means if you have money, you can buy coverage. That's the system we have now which leaves so many people out in the cold.

In the following article, Susan FitzGerald and Mark Jaffe of the Philadelphia Inquirer offer firsthand reporting on the two countries most similar to ours that have successfully reformed their health systems: Canada and Germany. These countries have both controlled costs and guaranteed equal treatment for rich, middle class, and poor alike.

How these systems work convinces us that the U.S. should adapt the principles that operate well in other systems and jettison those that don't. Whatever the other two systems' failings, it is essential to remember how much better they are than ours even with their problems. It is important to realize, too, that neither the Canadian nor German system need be carbon-copied [see "Socialized Medicine Now--Without the Wait," Nancy Watzman, October 1991]. We can work out the kinks and have national health care without waiting. The Congressional Budget Office (CBO) says single payer would provide universal coverage and still save an additional $14 billion a year. The General Accounting Office points out that with the equipment the U.S. already has, we could still provide high-tech treatments for everyone without resorting to waiting lines.