State Leadership Conference

The potential for revamping the nation's struggling health-care system has dwindled over the last two years, Princeton University sociologist Paul Eliot Starr, PhD, told State Leadership Conference attendees during his keynote address.

"With the resources our society possesses, especially with the means of treatment that we have today that did not exist in the past, we could do so much better than we do," said Starr, who 10 years ago helped write the failed health-care reform plan of then-President Bill Clinton. "The trends shaping health care today are not leading us toward realizing that great promise. They are taking us in a direction of a far worse crisis in health care than we have experienced so far...unless, that is, we change national policy from the path that it's on."

The situation today is a stark contrast from the late 1990s, he said. Then, the nation's booming economy and state and federal budget surpluses made reforms look feasible, including instituting universal health insurance and addressing the long-term problems Medicare faces in serving the baby boomer generation.

"The change in prospects for health care from just two years ago is stunning," Starr said. "And there is one factor above all that accounts for it, and that is the fiscal deterioration of government at both the national and the state level."

Two years ago the federal government projected a $3 trillion surplus over the next decade, but now it projects a $2 trillion deficit by then, he said. Moreover, war with Iraq could cause the deficit to hit a new all-time high, with devastating implications for health care, Starr said. "We may well have lost the chance of preserving the existing Medicare program at anything like the level of generosity that we now have," he explained.

Starr cautioned against plans that propose to overhaul Medicare by converting the system from a plan that specifies which services are covered to a plan that offers specified dollar amounts. The result, he said, would be that low-income elderly will gradually lose benefits because of inflation.

"Things don't look very good now, but it is possible to turn things around," he added. In order to do that, Starr said, a health-care reform plan must emerge that is politically practical, drawing a large enough support base to make it through Congress.