Pitfalls of health care reform.

• Author: Bresler, Robert J.
• Position: Column

The health care debate is one of the most vexing in the history of modem American political reform. It could produce the largest advance of the contemporary welfare/entitlement state or be the last gasp of liberal reform. If the efforts to overhaul the present health care system fail, it will be because it promises to do four things that contradict themselves: extend medical care to all (universal coverage); reduce medical costs in both the private and public sector; continue the current rate of advancement in medical technology; and preserve the patient's right to choose his or her own doctor or form of medical care. Most of the current proposals can accomplish some of these things, but none is likely to do all.

Woven into this debate is the ideological struggle between those favoring government-mandated solutions and those looking to the free market. At the mandated end of the political spectrum is the single-payer proposal, introduced by Rep. Jim McDermott (D.-Wash.) and Sen. Paul Wellstone (D.-Minn.), with over 90 sponsors in the House (including most of the Black Caucus). In comparison to Pres. Clinton's eye-crossingly complicated proposal, the single-payer has the appeal of simplicity. It virtually would nationalize the health insurance industry by establishing a universal coverage plan whereby the Federal government would collect premiums and pay providers. The plan would feature free medical care (no deductibles, no co-payments) for all Americans, who could select their own doctors; it would be supported by a new payroll tax (8.4% for large employers, 4.0% for small employers, and 2.1% for employees); the states would be responsible for administering the plan; Medicare and Medicaid would be brought into the system; and a national board would establish the standard benefit package, oversee state implementation, set national and state budgets, and determine who would be a qualified provider.

The McDermott plan may produce two of four things promised by reform - extend medical care to all and cut medical costs. It would reduce marketing and administrative costs of private insurance. The Congressional Budget Office (CBO) estimates that it would lower health care expenditures by six percent in 10 years, but there are numerous warning lights around this proposal. A similar system in Canada suggests that the single-payer plan would introduce rationing by government boards into the system and reduce the access many have to high-quality...