Lancet Ponders Post-Election Health Care System

With Republicans clinging to "narro[w] margins" in Congress and the presidential race between Texas Gov. George W. Bush (R) and Vice President Al Gore still undecided, Americans remain "sharply divided" on many issues, including health care reform, which may prevent lawmakers from passing any "significant" legislation, the Lancet reports in its Nov. 18 issue. "My feeling is that there is no consensus. If you were a betting man, you would bet that very little will happen in Washington," Rep. Jim McDermott (D-Wash.) said. McDermott said, however, that Congress may pass health care legislation if Republicans can "reach out" and compromise with Democrats. "We have to sit down and talk to each other if we're going to get anything done," he said. But according to Robert Moffit, director of domestic policy at the Heritage Foundation, compromise remains unlikely. "The atmosphere here in Washington is sulfuric; it's poisonous," he said. Moffit added that Bush would have a "better chance" to build a bipartisan coalitions with "battle-hardened, old-line" Democrats than Gore, who is seen as a "fierce and bitter partisan," would have with Republicans. "That's [Bush's] record; that's a fact," Moffit said. Democrats, however, may avoid tackling health care in the 107th Congress, hoping to recapture the majority in 2002. Still, despite the obstacles, "substantial" public pressure may force Congress to move on health legislation, with health care costs rising at a rate of more than 6% per year. In addition, the number of uninsured individuals in the United States stands at 42 million, about one in seven Americans. "The polls say health care is a big concern," McDermott said, adding, "If you have coverage, you're worried about how you're going to hang on to it, pay for it and whether it will be there when you need it." Pressing the Hot Buttons For lawmakers, patients' rights legislation will likely prove the "easiest" to pass, with the House already approving the Norwood-Dingell bill (HR 2723) and many states enacting their own versions. According to Robert Reischauer, president of the Urban Institute, Bush, if elected, should urge Senate Republican leaders to pass a patients' rights bill by June. "It would be an easy way for Bush to reach out to the other side," he said. Bush health care adviser Bill Roper agreed, noting, "It's not all that complicated and the areas of differences are well known, so it should be possible to work out a compromise." Medicare reform, however, will require "much more technically challenging and far-reaching" legislation, leading Reischauer to say, "I don't think it's going to move forward." In addition, Democrats may save the issue as a "rallying point" for the 2002 election. Still, last year, Congress discussed a Medicare reform plan -- backed by some Democrats -- similar to a proposal that Bush offered during the campaign, leaving some hope for legislation next year. Even Gore's running mate, Sen. Joseph Lieberman (D-Conn.), "was for it before he joined the Gore ticket. It's not impossible to craft a Medicare proposal that will muster enough support," Moffit said. On the issue of the uninsured, Reischauer pointed out that Bush may sway Democrats to back his large tax-relief package by offering tax credits to help families purchase health coverage. McDermott, a supporter of nationalized health care, agreed, concluding that such a proposal may prove the "only way" to tackle the problem because of the current "antigovernment tenor" in the United States. "The well has been poisoned against a government system," he said (McCarthy, Lancet, 11/18).