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Health Care Needs a Better Prescription

February 09, 1992

President Bush's health package is too haphazard, too full of contradictions and too fuzzy on such important issues as universal health insurance to be taken seriously.

It is less a plan of attack on flaws in American health care than a shield to ward off election-year charges that he has no plan. It is a feeble response to the concerns of millions of Americans who are looking to national leaders to provide a safety net for the increasing numbers who cannot afford to be sick--and who don't even have access to preventive health programs to keep them well.

One example of contradiction in the Bush plan is the claim that it would "ensure every American universal access to affordable health insurance." Officials in his own Administration admit it would leave nearly 5 million people without coverage.

That is an improvement over the 40 million Americans who have no health insurance and the millions more who have too little to deal with serious medical emergencies. But it hardly qualifies as health reform.

The Administration's approach is fuzzy on a crucial problem--the steeply rising costs of health care.

Bush pointed out that the cost of the federal program designed to provide basic care for the very poor, known in California as MediCal, "will increase by 38% this year alone." "We can make real savings simply by reducing this huge rate of increase," he said.

But he would achieve that by capping the federal share of state-administered Medicaid programs and leaving states to make up the difference or whittle down their programs.

With Medicaid already paying doctors and hospitals half or less of the amount that Medicare programs for the elderly pay, the idea could well mean worse rather than better health care for millions of people.

What is lacking is a comprehensive approach enlisting doctors, hospitals and the public in well-organized efforts to control excessive fees or reduce the upward pressure that new medical technology puts on costs.

The centerpiece is a proposal to spend $100 billion over five years for tax credits--or allowances for families too poor to pay taxes--to offset the cost of buying health insurance.

Some health-industry officials said the credits--starting at $1,250 a year for individuals and rising to a maximum $3,750 for families--would not cover the average $6,000 annual premium now paid by firms or families.

Complicated issues often suffer in the combative atmosphere of campaigns. And at least the Bush Administration has addressed the issue. Democrats have their own assortment of plans. And one official said the American Medical Assn. is encouraged that Bush has joined in giving health a high priority. That may be true, but the health care system is too close to true crisis and too important to millions of Americans to get a half-baked plan.

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