Feds take a stab at health care reform.

• Author: Harden, Shelda
• Position: Congress attempts to solve the health care crisis - Includes related articles

Proposals for health care reform are proliferating at the federal level, but consensus seems elusive.

Despite the fact that in 1992 Americans are expected to spend more than $800 billion on health care--more than any other industrialized nation--the United States ranks near the bottom on world measures of public health. We are eighth in the world in life expectancy, 11th in maternal mortality, 18th in child mortality and 22nd in infant mortality.

"As lawmakers in this country search for answers to escalating health care costs and coverage for the numerous uninsured, other nations have addressed these problems more successfully by combining regulatory and free market approaches," says Lynn Wagner of Modern Health-care. According to a study by the General Accounting Office, France, Germany and Japan came out ahead of the United States in controlling costs and providing universal access to care.

Oregon and Hawaii passed legislation in the past few years to control health costs and expand coverage. More recently, states are doing everything from the Health Right package in Minnesota, designed to offer affordable health care to all the uninsured in the state, to cost containment measures requiring health care providers to operate under a "unified health care budget" in Vermont.

Former Colorado Governor Richard Lamm suggests that "rather than rush into a patchwork system slapped together by politicians in an election year, [we should] use individual states as experimental laboratories to find what works."

Congress, nevertheless, has seen more than 150 bills introduced his session dealing with health care reform, including 50 major proposals.

The discussion of the health care system continues to focus on three financing options: expanding the current employment-based insurance system, guaraneeing coverage through a single-payer, government-supported system, and reforming the private insurance market.

"Pay or Play"

The proposals to provide comprehensive access by building on the current, private system retain "the element of health insurance that is characteristically American--it is usually a job benefit," according to The New York Times. Under these proposals, called "pay or play," employers would be required to provide a package of health insurance to their employees and their dependents or pay a tax into a state-administered pool. The payroll tax would be used to provide health coverage for anyone not insured by an employer, as well as for unemployed and indigent, and sometimes to provide long-term care for the poor.

Currently, an estimated two-thirds of the nation's 39 million uninsured are workers and their dependents. In fact, the number of people with employment-based insurance dropped to 138.7 million in 1990--from 140.8 million in 1989.

Legislation introduced by Senate Majority Leader George Mitchell allows private companies to choose between providing coverage to employees and their families or making a contribution to an expanded public health plan. California Congressman Robert Matsui's plan requires employers to provide health insurance coverage for children and pregnant women.

Pay-or-play proponents claim that mandating employer-based insurance is the most direct path from the current system to one that offers universal access.

The "Health America" plan introduced by Senators George Mitchell (Maine), Edward Kennedy (Mass.) and Donald Riegle (Mich.) and bills authored by Represenatatives Henry Waxman (Calif.) and Dan Rostenkowski (Ill.) include elements of pay or play by building on...