Medicare Shows Why Gore Should Hesitate To Go Left on Health

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Morton Kondracke Pennsylvania Avenue November 21, 2002

As he considers what kind of "single-payer" national health system to advocate, former Vice President Al Gore ought to look at Medicare's impending doctor crisis and be warned.

Physicians are considering abandoning Medicare patients in droves because the federal government is about to cut their reimbursement rate again and Congress seems unwilling to do anything about it.

It's a warning of what could happen if the entire U.S. health system is government-dominated - and, ultimately, politicized.

Gore told a New York audience last week, "I think we've reached a point where the entire health care system is in impending crisis. I have reluctantly come to the conclusion that we should begin drafting a single-payer national health insurance plan."

Gore's use of the term "single payer" seems to signal that on yet another issue - like Iraq, corporate corruption and, lately, terrorism - the Democrats' 2000 presidential nominee intends to run in 2004 by going to the left of the rest of the field and of his own prior record.

After the 1991 Persian Gulf War, Gore favored toppling Saddam Hussein. Now he does not favor it, at least until after the war on terrorism is won.

Yet, even though he considers terrorism America's top security threat, he told National Public Radio this week that the Bush administration is endangering basic U.S. liberties to fight it.

And he's served notice that he's going to press forward with the populist theme of his 2000 Democratic National Convention speech, in which he depicted American politics in class-warfare terms - "the people against the powerful."

Gore is right to say that the current health system is approaching crisis, with the ranks of the uninsured surpassing 41 million, costs rising at 15 percent a year and higher, and workers increasingly forced to pay more of their insurance premiums themselves.

Former aides who have talked to Gore say that he has not settled on any specific "single-payer" national health formula and that he wants one that will achieve consensus among doctors and other providers, employers and consumers.

That suggests to these aides that he does not have in mind a system like Canada's or the U.S. Medicare system for seniors. In both, government decides what services and procedures will be covered and at what cost. Private insurers basically are cut out.

It would be good if Gore avoids the Canada-Medicare model, but it would be a disappointment to most advocates of single-payer plans, who claim that government programs are more efficient than the current private-insurance system that covers most Americans.

But their view is disputed by critics, who point out that neither Canada's health system nor Medicare - but almost all private insurers - cover prescription drugs, the basis of much of modern medicine.

Critical researchers also assert that Canada's system has produced long waits for elective surgery, biopsies, visits to specialists and magnetic resonance imaging - and increasing travel to the United States for care.

In the May-June 2002 issue of the journal Health Affairs, researchers reported that in surveys conducted in 1988 and 1990, 56 percent of Canadians thought their health system needed "only minor changes."

But in 2001, 59 percent said that it needed "fundamental changes" - a somewhat higher percentage than in the United States, where 51 percent called for basic change.

The current U.S. crisis in Medicare arises from a government underestimate of participation on HMO programs and a huge miscalculation of the money needed to reimburse doctors.

As a result, the government cut doctor reimbursements by 5.4 percent last year. Another 4.4 percent cut is scheduled for January. Over the next three years, doctors are due for a total cut of 12 percent.

As a result of the cuts, doctors increasingly are not taking new Medicare patients and some are refusing to treat Medicare patients at all.

In a survey by the California Medical Association, 58 percent of doctors said that new cuts would lead them to not take new patients and 20 percent said they would drop Medicare patients.

The House last week passed a bill allowing the federal Centers for Medicare and Medicaid Services to cancel the new doctor cuts administratively without fear of lawsuits from other providers - including hospitals, HMOs and nursing homes - that want reimbursement increases.

However, the Senate Finance Committee is likely not to pass the measure because key Senators want other providers, especially rural health centers, to get payment increases.

There are comprehensive alternatives to government-run medicine, which Gore ought to consider.

One is the plan proposed in 2000 by his Democratic rival, former Sen. Bill Bradley (N.J.), allowing all Americans to buy into the Federal Employees Health Benefits Program.

Bradley's proposal provided a tax credit to enable lower-income persons to participate in the FEHB program and eliminated the state-managed Medicaid program - a point over which Gore savaged him in the 2000 campaign.

The FEHB program is not really a "single payer," however. It negotiates with private insurance companies to provide federal workers with an array of reduced-premium private plans to choose from.

With variations, the late Sen. Paul Wellstone (D-Minn.) advocated an FEHB plan and so do many "New Democrats" and some Republicans.

Some former Gore aides think he might come up with such a plan, too. That would be good. If he insisted on calling it "single payer," though, it would be populist positioning.

-- Anonymous, November 21, 2002


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