What's blocking health care reform?

Common Cause Magazine, Jan-March, 1992 by Vicki Kemper, Viveca Novak

For all his decrying of the health care crisis, Pennsylvania Democrat Harris Wofford can say one good thing has come of it: It fueled his unexpected Senate victory over former Attorney General Richard Thornburgh last fall.

Early in the campaign, underdog Wofford discovered that voters were obsessed with the skyrocketing costs of health care, their difficulties in obtaining health insurance and Washington's seeming indifference to the problem. He devoted five television ads to health care, saying that "if criminals have a right to a lawyer," sick Americans should have the right to see a doctor.

Pennsylvania voters responded; post-election polls suggested that one of every three votes for Wofford was cast soley for his position on health care. Wofford campaign manager Paul Begala may have put it best: "This issue is strong enough to turn goat spit into gasoline."

Wofford's surprising victory over Thornburgh guarantees that health care reform will be a hot-button issue in this year's congressional and presidential elections. Opinion polls indicate that 90 percent of Americans believe the nation's health care system needs "fundamental change" or a "complete rebuilding."

In December, Wofford and three other Democratic senators -- Majority Leader George Mitchell of Maine, Jay Rockefeller of West Virginia and Bob Graham of Florida -- toured hospitals and held health care hearings in five states. On January 14 Democratic members of Congress held some 285 town meetings across the country focusing on the issue. Democratic presidential candidates are formulating their own proposals and talking up reform in stump speeches -- knowing that with 34.7 million people uninsured and health costs growing at twice the rate of the sluggish GNP, millions of Americans have concluded only government intervention can remedy the nation's ailing health care system.

For much of the past year reform proposals -- calling for everything from minor treatment to major surgery -- have been pouring out of medical associations, insurance companies, labor unions, businesses, grassroots organizations and ad hoc coalitions. Even the American Medical Association (AMA), which has used money and hardball politics to fight government-sponsored health care programs since the early part of this century, has its own limited prescription for universal coverage. Dozens of reform bills are pending in Congress.

But whether electioneering and political rhetoric will translate into concrete action is another question. Given the obvious need for change, who or what is standing in the way?

For starters, Democrats point to the White House, where President George Bush and his advisers have met repeatedly with industry leaders since Wofford's win. In December, after two-and-a-half years of study, an administration advisory panel rejected calls for a systemic overhaul and instead suggested only limited reforms, including an emphasis on "healthier lifestyles." Panel chair Deborah Steelman, a key Bush adviser on health care issues, is a lobbyist who represents the Pharmaceutical Manufacturers Assocsiation, Aetna Life & Casualty and other companies that oppose broad reforms.

Bush laid out his opposition to major change in his January 28 State of the Union message, proposing only a tax credit for low-income individuals who buy health insurance and promising more details in February. After a last-minute rebellion by congressional Republicans, the administration stopped the presses and stripped further, though modest, proposals -- including taxing wealthy Americans' employer-provided health benefits as income -- from its 1993 budget request presented the day after the president's message.

Congress has not done much better. Many Democrats want comprehensive reform but can't agree on what kind. A Senate Republican task force, after months of caucusing, produced a proposal that leaves the current system essentially intact, and a group of House Republicans met weekly for more than six months without introducing a bill.

Meanwhile, doctors blame lawyers and the government for the current mess. Health care purchasers point to insurance companies that cover only the healthy, while insurers single out greedy doctors and hospitals and unrealistic consumers. Outside analysts frame the problem as a lack of consensus; public interest groups define it as a lack of political courage; and everybody talks about how complicated the issue is.

For all this finger-pointing, few in Washington are willing to blame what may be the biggest culprit of all: the political influence of special interest groups with a vested interest in the status quo. The same insurance companies, doctors, hospitals and drug manufacturers that live off the $700 billion-a-year health care industry are battling comprehensive reform on Capitol Hill and at the White House.

"If the elected officials listen to the public, there are some pretty clear messages," says Stephen McConnell, senior vice president of the Alzheimer's Association. "But if they listen to the organized lobbyists," he adds, "it's a stalemate."