clock menu more-arrow no yes

Filed under:

QUEST FOR CHEAPER HEALTH CARE LIKELY IS AN IMPOSSIBLE DREAM

Health-care reform seems about to sink below the horizon. There's not enough time left this fall to act and not much pressure to do so. But the general assumption is that next year, Congress and the administration will try again.

In fact, it's not very likely. But we aren't finished with health care quite yet. It will be used with a vengeance by both sides in the fall campaign.True, many voters are bored with the whole subject and say they are relieved that nothing has been done so far. After all, so many proposals were put forward so often by so many that people simply became confused and wary of any plan.

But some politicians see profit in the politics of blame. They will insist the failure of reform proves gridlock still prevails in Washington. Another failure of government exposed! Why can't everyone just work together in the national interest?

That's the Perot argument, of course, and cuts against both parties, though with precisely what effect no one knows. But it does cut.

Meanwhile, some Democrats will claim the GOP proved it is the handmaiden of special interests. It's a good way to energize liberal voters.

Republicans have an equally good line: President Clinton's plan, and its several varieties in Congress, represented the ultimate government grab for power. It gives them an excellent chance to beat up on those who believe government can still work.

This can cost the Democrats plenty of votes, particularly as the details of Hillary Clinton's Task Force on National Health Care Reform begin to come out.

A court case to open the files succeeded earlier this month. The chaos of the deliberations of the 200-odd associates of the first lady and task force czar Ira Magaziner make appalling reading.

Treasury was deliberately kept out until the last minute. The financing problem was never squarely faced. Many on the task force kept insisting the plan would never work.

So the politics of health are still very much alive. But come November, the issue is finally likely to die.

To ensure the 15 percent now without coverage enormously complicates the financing of Medicaid, which takes care of the really poor. Even minor reform costs far more than most imagine. It also re-opens the agonizing question of just what benefits to provide, which was never really faced this year.

The problems are endless, daunting enough to frighten away almost everyone. Absent significant public pressure for reform, there is every good political reason not to act.

Reform will go on the shelf for a long time, perhaps for several years.

It's just as well. Given the fatal collision of interest groups and the hopeless confusion surrounding reform, there is really only one way through: a dedicated tax to pay for a standard benefit package for everyone. It's how most countries manage health care.

But right now the American people want no part of any tax, dedicated or not, for health care or anything else. Until they change their minds, health-care reform isn't worth doing, because it can't possibly be done right.

And even if the public does change its mind, there remains the problem of deciding what to cover. The Clinton plan always envisioned more benefits than the economy could reasonably afford.

One must doubt whether the public will soon sanction the hard choices that might solve these problems or that either party will want to risk tackling them.

A final problem: Some experts suggest that if all imaginable waste could be eliminated, the march of technology and the new cures it brings will keep pushing costs upward, no matter what. In short, there may be no road at all to cheaper health care.