Greetings, Congress--Guess What’s Waiting : Returning legislators again face health care reform issue

As members of Congress return from vacation today they will find the matter of health care reform waiting for them: As much as many might wish otherwise, the issue just won’t go away.

In an odd alliance, liberals and conservatives have locked arms in hopes of blocking any health care reform this year. It is true there is virtually no chance that comprehensive change will occur in this 103rd Congress, but it would be a mistake for legislators to make no improvements at all simply because every worthwhile change is not politically possible now.

The two forces opposing reform have very different motivations. The liberals, usually Democrats who support a “single payer” Canadian-style health care system, see anything less than a system overhaul as a failure; conservatives, in this situation usually Republicans, are looking to pick up some GOP victories in November and don’t want to hand President Clinton anything that could be seen as a political victory.

Neither agenda seems to us to move toward what most Americans want: gradual change that doesn’t threaten what works in the U.S. health care system, and help in getting and keeping affordable health insurance.

Some facts that Congress should bear in mind whenever it discusses health care reform:

About 15% of Americans lack health insurance. Among the employed, the uninsured are concentrated in the nation’s smallest firms, 73% of which do not offer employees insurance coverage. Small businesses, many of which are struggling, say they simply cannot afford to offer employees the insurance coverage offered by 98% of large firms.

So what can Congress do to make it easier for employees of small business, and the self-employed, to get affordable coverage?

One way is through health insurance purchasing cooperatives, which allow small groups of employees to band together to get better rates and greater variety in insurance coverage.

Small employers should be obliged to join such cooperatives, though not to pay for employee coverage. The Health Insurance Plan of California, set up by the state but privately run, has driven down premiums 10% for members during the last year. That’s not exciting stuff for politicians looking for big flags to wave, but it’s real improvement. And it is duplicable.

Another issue on which Congress could agree is insurance reform. Washington must take care not to repeat the mistakes of New York state, which barred insurers from setting premiums based on age, sex or health status. That sounds good on paper, but the effect was to send the rates of young, healthy people skyrocketing--and when the young and healthy abandoned the system, premiums shot up as much as 170% for everyone else. Premiums should be adjusted by age, because they must somehow reflect the fact that an average 25-year-old’s medical bills are one-fourth that of a 60-year-old.

The moderates on the Hill who still have hopes of enacting some measure of reform know the pitfalls of a little reform done badly. But they also know the virtues of a little reform done well. Comprehensive health care reform cannot and should not be hurried through this year. But it can and should be begun, and there will never be a better time than now.