Is It Worth It to Go Halfway?
Slade, Steve
HEALTH CARE FOR ALL IS IT WORTH IT TO GO HALFWAY? STEVE SLADE The United States appears to be marching relentlessly toward some form of national health insurance (NHI). There is no...
...Lerner's conclusions may surprise us because we are accustomed to assuming that medical care is the only critical determinant of health...
...But medical sociologists have documented a wide variety of cultural, behavioral, and environmental factors which contribute substantially to health or illness...
...We must ask ourselves, therefore, whether it is worth it to go halfway toward NHI...
...This experience is likely to be replicated and aggravated by the kind of national insurance system that the health industry and the Administration will try to persuade Congress to enact...
...Daily hospital service charges led the upward surge with annual increases of 13.4 per cent...
...After a study of the links between poverty and health, Professor Monroe Lerner of the Johns Hopkins School of Medicine concluded that the poor experience "substantially higher rates of overall mortality, infant mortality, and severe illness" than those in higher income brackets...
...He has done substantial research in recent years on many aspects of the health care delivery system in the United States...
...As the debate over these conflicting approaches and sundry alternatives unfolds, and as countervailing pressures are brought to bear on Congress, liberals, who have rightly helped create public clamor for NHI, are likely to face a cruel choice between no bill at all or one which perpetuates the present system of vast expenditures, unjustified waste, and inadequate cost controls...
...With the limited resources available to meet our vast needs, we cannot afford huge expenditures on unnecessary medicine...
...The impact of these programs on medical prices was staggering...
...While costs doubled, enrollment in Medicare increased by only eight per cent...
...Rather than march blindly toward some vague and distant goal of national health insurance, we must begin to ask ourselves where we are going and whether we really want to go there...
...In consequence, we have seen one Federal health program after another fail in frustration...
...it is little more than the continuation of private insurance by other means...
...The crucial difference, however, involves neither cost nor comprehensiveness of coverage...
...The nature and power of the medical-industrial complex requires radical changes in payment and delivery mechanisms, but it almost guarantees the continuation of current practices...
...The price for this commitment was paid in the Medicare and Medicaid programs as costs rose from $3.2 billion in 1967 to $7 billion in 1970...
...Social programs which help alleviate these elements of poverty will substantially improve the health level of the poor...
...As the legislative process works its way toward compromise, we must begin to face these questions of priorities because we cannot have all that we want nor do all that needs doing...
...It centers, rather, on the question of whether Federal financing will be used to exert leverage over an enormously costly, wasteful, and inefficient system of health care delivery...
...The Administration proposal not only leaves the current payment and delivery system largely intact, but guarantees a powerful and lucrative role to insur ance companies...
...The poor, whose health is the worst and whose need the greatest, will suffer most from the distortion of social priorities...
...The underlying Federal philosophy toward medical care is summarized in the preamble of the much praised Comprehensive Health Planning and Public Health Services Act of 1966, which pledges no "interference with existing patterns of private professional practice of medicine . . ." In other words, the Federal Government has committed itself to financing medical care without demanding significant changes in the method of payment or delivery...
...There is no longer significant public debate over the need for a greater government role in the provision of medical services...
...During the first three years of these programs, fees rose by twenty-two per cent and daily hospital service charges increased by fifty-five per cent...
...Senator Kennedy and Representative Martha Griffiths of Michigan are sponsoring broad legislation covering virtually the full range of personal health services for everyone...
...The loss of social programs will escalate with the costs of the Government's commitment to current payment mechanisms...
...If the medical-industrial complex succeeds in shaping the legislation that is to come, the result will merely be to frustrate our efforts for better health and warp our national spending priorities for years to come...
...But the Nixon and Kennedy plans represent radically different approaches to the form NHI should take...
...Following their adoption, the rate of inflation in medicine doubled to an annual rate of 6.6 per cent...
...mandated by the less comprehensive Nixon measure...
...Both President Nixon and Senator Edward M. Kennedy have pledged early action on the various insurance plans now before Congress...
...Lerner suggests that programs designed to alleviate poverty will also improve the health level of the poor...
...But the Kennedy-Griffiths proposal will cost the medical consumer less out-of-pocket, and supporters have made much of the co-insurance and deductibles Steve Slade is news and public affairs director of radio station WMKY at More head State University in Kentucky...
...President Nixon proposes a combination of three programs for various groups which leaves many medical services uncovered and bills unpaid...
...If the poor lack access to quality medical care, they also lack access to quality housing, good jobs, and nutritious food...
...The 1973 budget study of the Brookings Institution pointed out that public funds spent on NHI would not be available to meet "other high-priority public objectives...
...they will also be the programs most likely to go underfunded as escalating medical costs consume available public funds...
...HEALTH CARE FOR ALL IS IT WORTH IT TO GO HALFWAY...
...STEVE SLADE The United States appears to be marching relentlessly toward some form of national health insurance (NHI...
...Inadequate housing, nutrition, clothing, economic security, and education contribute to the total poverty environment and to the ill health of the poor...
...In the past, the political power of the medical-industrial complex has effectively limited Federal intervention in the payment patterns of medicine...
...Given this political-economic reality, the value of NHI must be weighed against the value of other social programs eliminated from consideration by NHFs high costs...
...The Kennedy-Griffiths bill seeks to control the medical industry by altering the traditional payment and deliv ery mechanisms and limiting the* role of the insurance industry...
...Nixon's plan will cost the Federal Government less, and the President has made much of the "new taxes" required by the more costly Kennedy-Griffiths bill...
...Unfortunately, the American public seems willing to devote only a slowly growing portion of its GNP to public expenditures...
Vol. 38 • April 1974 • No. 4
