1992 Campaign Issue: Health Care


America's health-care system is sick and in need of treatment. Last year, the nation spent 12.5 percent of its gross national product -- a sum estimated at $671 billion -- in this field. Yet 34 million citizens lacked health insurance coverage.

During the 1988 election campaign, President Bush called for "access to health care for all Americans." The Republican platform said "every family should have the security of basic health insurance." Yet two and a half years later, the White House is mired in a task force study that is unlikely to publish its findings until the 1992 presidential election year. As is the case on so many domestic issues, Mr. Bush appears content with the status quo or only incremental change.

Now comes the Senate Democratic leadership with a plan that would guarantee basic health insurance for all citizens and create an independent board to set annual spending goals and negotiate with sectors of the industry to contain health care costs. All employers would be required to provide health care insurance or contribute to a public "AmeriCare" fund (replacing Medicaid) that would take care of the poor and the uncovered.

The major philosophical issue is whether the provision of insurance should be mandatory, as the Democrats propose, or voluntary with a lot of tax incentives built in, which supposedly will be central to the Bush program. Until this and other complex questions are settled, the country will continue to have a medical system notable for its technological excellence on the one hand and its wealth-based inequities on the other -- a system plagued by skyrocketing costs, inefficient use of resources, malpractice litigation and a widening divide between heroic procedures for those who can pay and inadequate care for those who cannot.

For many employers, health benefits are by far the fastest growing component of labor costs. Small business groups contend they cannot afford the premiums; larger companies that offer insurance resent employers who get a free ride. The Democrats may find they have more business support than might be expected.

One group that will have little sympathy for the universal-coverage approach is the health insurance industry itself, which contends voluntary means can be developed to cover most citizens. Hospitals and doctors also will resist induction into a de facto national health system, although their associations are praising the Senate Democrats for trying to launch a responsible debate.

If the White House finds itself under pressure on what may be a hot political issue, so much the better. President Bush himself should have come up with some definite proposals long ago instead of leaving it to his opponents in Congress. Of course, the government will be hard-pressed to find the federal funds -- estimated at $6 billion -- needed to launch a mandatory health insurance system, even though many times this amount is being wasted under the present system.

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