HEALTH CARE: A national crisis that cannot be ignored
(Pantagraph Bloomington IL; 07/26/98)

It will be another American milestone. The country that gave the world Instant Breakfast, jazz and the atom bomb may soon be the firstdeveloped nation to pass laws protecting its citizens from their own health care system.

That is what is likely to happen if our legislators can stop reading the polls long enough to negotiate a compromise between the "patients'  bill of rights" hyperbole of the Democrats and the "no government takeover of health care" paranoia of the Republicans.

As the rhetoric heats up and battle lines are drawn, however, it may be worthwhile to re-visit the issues that now make managed care a more popular political target than Big Tobacco.

While laws guaranteeing HMO members' rights to choose their own doctors, receive emergency room care and keep their medical records confidential will certainly help to check the more rapacious cost- saving tactics of managed care organizations, they will constitute only a Band-
Aid solution for the ills besetting American health care.

The fundamental problem is that the main goal of for-profit HMOs is not to provide care to individuals or support health for the general population, but to make money. This objective is achieved by limiting services.

Although thereis widespread agreement that controlling health care expense is necessary and possible, there is a singular lack of imagination about how this objective should be achieved.

These days, much discussion of managed care has to do with whether it is better than the old fee-for-service system. There is a lot of finger-pointing, with HMO defenders recalling the galloping greed of pre-'90s physicians and HMO attackers posing the rhetorical question of
whether a board-certified surgeon or a bean-counter should make the  decision to perform aortic bypass surgery.

This mudslinging is not constructive. The emotions it generates will not be soothed by consumer rights legislation.

Perhaps we should broaden and improve the value of the debate by asking one very important question: Is for-profit managed care the best way to deliver and pay for health care in the United States?

Increasingly, consumers and providers are saying "No." Furthermore, research indicates that for-profit managed care is not an effective solution to the challenges of cost, access and quality it promised to solve.

During the 1990s, the number of Americans who are un- or under-insured has increased dramatically. Accounts of poor quality care delivered by for-profit HMOs routinely make the news.

Managed care is not an option for many - the self-employed, rural residents and sick people in particular.

Finally - and, perhaps, most telling - managed care has been unable to stem the rise of health care costs.

Indeed, with HMOs themselves reporting declining profits, there are some serious questions about whether they can continue to make money while keeping the cost to consumers and employers low. Will their executives and stockholders even want to dominate health care delivery if the profits dry up?

So, what about consumer rights legislation? Instead of trying to fix a system that is imperfect, at best, and downright dangerous, at worst, let's go back to the drawing board.

It turns out that managed care is a more radical, less efficient, and less humane way to solve the U.S. health care challenge than a single-payer health care delivery system would be.

Such a system would take the place of Medicare, Medicaid, traditional health insurance and managed care coverage. It would reduce administrative complexity and cost-shifting. Most significantly, it would  focus on producing health - not profits.

In a single-payer system, one organization pays all health care bills.

THERE ARE MODELS provided by systems that operate successfully in countries including Canada, Australia and Great Britain; as always, the  devil is in the details. However, it is noteworthy that residents of  nations with single-payer systems uniformly give those systems the same  high ratings Americans reserve for Social Security and Medicare. Single-payer systems control costs, guarantee access and support quality of care.

Why shouldn't we have one in this country?

The answer, of course, is that some powerful special interests don't want it. A coalition of insurance and business groups is launching a $1 million advertising campaign against the patients' rights legislation pending in Congress. If they don't like this legislation, imagine what they think of single-payer health care!

At present, with both consumers and medical professionals recognizing the shortcomings of managed care, the only constituencies that benefit from not having single-payer health care are for-profit providers and payers.

A national campaign for a single-payer system would meet, once again, the tired old anti-government and Red Scare rhetoric. But, they would say that - wouldn't they?

Lucinda McCray Beier is director of the Applied Social Research Unit, Illinois State University.