Health Care And The Next Congress

Proposals to curb the growth of Medicare and Medicaid, as well as plans to give states more freedom to pursue their own health plans, will top the health care agenda in the next session of Congress, according to health policy experts interviewed by the New York Times. President Clinton and Congress should set their sights lower, worry less about the goal of universal coverage and try to make some modest improvements in the nation's health care system, they said.

If health reform is to succeed, it must be incremental and come in "bite-sized chunks," be simpler, less scary and less bureaucratic, said Drew Altman, president of the Kaiser Family Foundation. legislation on health coverage for children has political appeal, he said, and foresaw a major debate over caps and cuts in Medicare and Medicaid, driven by the need to cut the budget deficit rather than a desire to pay for expanded cover. State flexibility will be a major issue next year, predicted Senator Paul Wellstone, who wants to let states try single-payer plans. Some experts felt future reform proposals must rely less on federal authority and more on market forces which are already revolutionizing health care delivery in the USA.

"If The Public Won't Buy It, It's The Wrong Plan" Alain Enthoven of Stanford University, called by the NYT the "intellectual father of managed competition," said Mrs Clinton should try to find some common ground with those who defeated the plan, rather than just meeting with supporters. Other experts suggested that if Pres Clinton tries again on reform, he should start in the center of the political spectrum and build coalitions outward. Noting that the next Congress is likely to be more conservative, health economist Lynn Etheredge, who was a consultant to the reform Task Force, said a new proposal needs to be very different from what was rejected. If the public won't buy it, then it's the wrong plan, he said.