U.S. Health Care System Headed Toward ‘Danger Zone,” Opinion Pieces Warn

The U.S. health care system has moved "toward the danger zone" in the past year, and the "conditions are coalescing for a surge in the ranks of the uninsured, similar to the crisis of the early 1990s," Los Angeles Times reporter Ronald Brownstein writes in a column. The increasing number of Americans who lack health insurance will likely become a "growing public concern" in 2002, while the "return of federal budget deficits crimps Washington's capacity to reverse the trend," Brownstein warns. Although the rise of managed care and a strong labor market "reversed the seemingly inexorable rise in the uninsured" in the late 1990s, Brownstein writes that "these gains now look like merely the calm between storms." He points out that the "spiral of rising cost and reduced access is spinning again" in the United States. "Skyrocketing" prescription drug costs, "tougher negotiating" by hospitals and doctors and a "consumer and political backlash" that has forced insurers to "loosen the reins" on managed care have increased the price of health insurance, Brownstein writes, adding that the nation can expect "a long-term acceleration" in health insurance costs that will "renew pressure" on employers to drop or reduce coverage for employees. Meanwhile, an increase in unemployment as a result of the recession that began last March "means more workers are losing their insurance along with their jobs," while a "slackening" labor market has reduced "pressure on employers to court workers by offering coverage at all." In addition, Brownstein writes that the "budget squeeze" has forced states to "retrench their programs" for the uninsured. As a result, the number of uninsured Americans may have "swelled" by at least one million in 2001 and "possibly more," he writes, adding that the "figures for this year could be just as bad."

'Washington Intervention'?
According to Brownstein, the figures "ought to raise the question of how Washington will respond as the health care safety net unravels." However, he writes that the recession, increased spending on anti-terrorism measures and the 10-year, $1.35 trillion tax cut that Congress passed last year have "consumed the federal budget surplus that might have paid for expanding coverage." Although "federal money alone won't solve the deepening problem of health care access" without "greater public and private efforts to control costs," Brownstein concludes that "it's the indispensable foundation of a solution; without Washington intervention, the problem seems certain to worsen" (Brownstein, Los Angeles Times, 1/7).

Washington Post Columns Weigh In
Two Washington Post opinion pieces on Jan. 6 also discussed the need for health care reform. Reporter David Broder writes that with the U.S. health care system "threatened with meltdown," the issue "cannot wait for the war on terrorism to end." He adds, "[T]inkering around the edges cannot, for long, withstand the adverse trends that are at work, let alone reverse them. ... [The issue] needs attention from the president and Congress. And it needs it now" (Broder, Washington Post, 1/6). Lewis Sandy, a physician and executive vice president of the Robert Wood Johnson Foundation, writes, "Health care is among the knottiest, most complex and thorniest of all national issues. It is disheartening that our apparatus for dealing with it doesn't seem up to the task." With its failure to pass an economic stimulus package in December, Congress "has essentially punted on the problems until next year." As a physician, Sandy notes, "I have a professional and moral obligation to provide the best possible care to my patients. Walking away from their problems is not an option. I wish that our national leaders felt the same way" (Sandy, Washington Post, 1/6).