Professional Point

It's a new year and a new Congress, but old problems remain: double-digit health-care inflation, increasing numbers of people who are uninsured and continuing obstacles to the ability to access quality health-care service. Perhaps more than ever, a consensus within the health-policy community recognizes that a market-driven managed-care approach to these problems has been ineffective. Except for a short-lived slowing in the rise of health-care costs in the late 1990s, managed care failed to "fix" the cost problem. Further, managed care has led to quality and access problems that have made matters even worse.

What has not found consensus, however, are any concrete solutions for these continuing, if not worsening, problems with health care. Even the incremental efforts considered by the 107th Congress to reform the health-care system stalled--partly as a result of the events of Sept. 11, 2001, and their aftermath, and partly because of an inability to agree on just how much "teeth" and enforcement to include in the effort to protect patients and assure access to quality health care.

Importantly, the question that looms now is whether the 108th Congress will be any more able to come to some agreement about appropriate reforms for health care. A more cynical version of that question might be, "Will the current Congress even address health care?" While predictions of events and outcomes are always risky business where politics are concerned, signs point to certain actions.

On the health-care horizon

Early indications are that a prescription drug benefit for Medicare beneficiaries is definitely on the Republican-controlled congressional radar screen, along with some generalized notions of a need to reform aspects of the Medicare program. "Doing something" for the now 41 million uninsured also seems to be getting some recognition, particularly in light of anticipated increases to that number as more and more cuts to Medicaid dollars occur. Mental health parity continues to have bipartisan support; this, combined with the sentiments of many in Congress that significantly improving parity would provide a fitting memory of the late Sen. Paul Wellstone, gives the legislation a very good chance of becoming law.

Patient-protection legislation may not fare so well. While there has been considerable agreement about many components of the patient-protection legislation, the extent to which managed-care companies can and should be held liable for injury caused by cost-cutting has not found such agreement. In a Congress that appears likely to take up medical malpractice and tort reform, it is unlikely that a patient's right to sue negligent managed-care companies will receive much "floor time."

Specific health-care legislation aside, the call for health-care reform will gain increasing momentum as the 2004 presidential election approaches. Depending upon the turn of events related to Iraq, North Korea and the country's ongoing war against terrorism, it is even possible that health-care reform could become a defining issue in the next election, much as it was for Bill Clinton in 1992. As costs and the numbers of uninsured continue to rise, and as employers, consumers and health-care professionals all continue to be frustrated and dissatisfied with the current health-care system, presidential candidates from both parties may be judged by the electorate on the merits of their proposed solutions to health-care's problems. Republican and Democratic attempts to distinguish themselves through their positions on health-care reform could result in competing reform plans and lively debate preceding the election.

In the past, a partisan approach to dueling health-care reform proposals has often times pitted a legislated universal health-care reform proposal against a market reform solution. That could happen this time as well. Remember Al Gore's statement while "testing the waters" for a possible bid for the presidency that he had "reluctantly" come to the conclusion that a single-payer system achieved through comprehensive reform was the only solution? Juxtapose this with an increasing number of employers "experimenting" with a consumer-driven or defined contributions approach to health-care reform in the marketplace.

History and experience have shown that approaches to health-care reform born of ideologic polarities and lacking bipartisan support have not been politically successful and, more importantly, have not solved this country's health-care problems. Perhaps it's time to attempt a more bipartisan, integrated blending of the best of each of the approaches. Whether or not that can happen at a time when the two parties are vying for the White House is anybody's guess.