WASHINGTON -- In a setback to President Clinton's effort to control health costs, federal officials have discovered that the government no longer collects the data needed to set a health budget for each state, as Mr. Clinton had promised to do in the 1992 campaign.
The discovery forecloses one method of controlling health costs and forces the Clinton administration to seek other ways of achieving the same goal, perhaps through direct federal regulation of prices in the health care industry.
In the campaign, Mr. Clinton had said he would set a national limit on all health spending, public and private. Under the overall limit, he said, the federal government would set a health care budget for each state and give the states maximum flexibility in deciding how to control costs and provide coverage for the uninsured. A state would be free to design its solutions, as long as it stayed within its budget. The state budgets were to be computed from current health spending adjusted for population changes, inflation and other factors.
But members of the president's Task Force on National Health Care Reform, headed by Hillary Rodham Clinton, discovered last week that the government stopped collecting state-by-state data on health spending a decade ago.
The federal government tabulated health spending by states from 1966 through 1982, but has not compiled state data since then, apparently because federal officials did not need such information to run the Medicare and Medicaid programs for the elderly and the poor.
Thus, the study group members said, it will be virtually impossible to establish a reasonable budget for each state that can withstand legal challenge. At the moment, they said, states have no reliable way to keep track of health spending outside public programs like Medicare and Medicaid. Federal, state and local programs account for less than half of all health spending.
Lynn M. Etheredge, a health economist working for the president's task force, said: "We have no ability to track spending at the state level, let alone set budgets in a rational way. Even our national spending estimates are two to three years behind. It's easy to put together a numbers exercise and just say health care will be X percent of gross domestic product. But how, in fact, do you budget 14 percent of our economy? How do you make this work? The practicalities are overwhelming."
The 1982 data showed that states varied immensely in the level of spending for health care, the growth of such spending and the mix of services purchased with health care dollars. Per capita spending for health care in 1982 ranged from a low of $857 in South Carolina to a high of $1,508 in Massachusetts. California and New York ranked second and third, with per capita spending of more than $1,400 each.
White House officials said Mr. Clinton is likely to propose health spending goals and new techniques for collecting data, but not a firm budget for each state.
In the absence of reliable data on state health spending, administration officials are seeking other ways to control costs. Confidential work papers of the president's health care task force show it is considering a wide range of "interim cost controls," including federal limits on doctors' fees, hospital charges and private health insurance premiums. But White House officials insisted that these controls will be temporary.
In addition, Paul Starr, a professor of sociology at Princeton University who is working at the White House, proposed this month that states limit the average premium paid for each person in a health insurance plan or a health maintenance organization. The payment, he said, could be set to limit total spending in each state.
Health spending now accounts for one-seventh of the nation's entire economy. The U.S. government estimates national health spending using data from a variety of sources.