WASHINGTON — HOUSE Speaker Thomas Foley speaks bluntly about what runaway health care costs are doing to the United States. "This thing is a monster that is eating us alive," he says.
Representative Foley, a Washington State Democrat, is not alone in his concerns. Congress, the president, and the nation's governors all describe the health care crisis as America's No. 1 economic problem.
President Clinton says flatly that unless health costs are curbed, "It's going to bankrupt this country."
Today the nation's governors take their growing anxiety about health costs directly to Mr. Clinton in what they describe as an "unprecedented" two-and-one-half-hour meeting at the White House. They will urge the president to overhaul the US health care system within the next few months.
Gov. Roy Romer (D) of Colorado, chairman of the National Governors' Association, says Clinton has an unusual, but brief, political opportunity now when both Republicans and Democrats are ready to support action.
Why so much urgency over health care? Governor Romer says constantly rising health costs could bankrupt American government in the next century unless there is immediate action. Spending is almost completely out of control:
* In 1992, total US medical expenses reached $809 billion, or more than $3,200 for every US resident. Government paid nearly half of that.
* In fiscal year 1992, costs soared for the Medicare program for the elderly and Medicaid for the poor. Government outlays for the two programs hit $252 billion, and soon will exceed both Social Security ($267 billion) and defense ($282 billion).
* In 1980, health care consumed 9 cents of every $1 produced by the American economy. Today it consumes 13.4 cents. By 2000, the figure will rise to 17 cents - unless Clinton acts.
* In 1993, despite the highest medical spending on earth, the US had an estimated 35 million people with no health insurance.
Governors, whose budgets are being pummeled by Medicaid costs, desperately need help. At their annual meeting this week in Washington, they agree that two changes are urgently needed: First, everyone must have health insurance; second, government must establish a system to control costs.
What is striking is that virtually all the governors, Republicans and Democrats, seem to concur on many details of what health-care reform should include. They will vote on the specifics tomorrow.
Like Clinton, the governors favor the concept of "managed care." They would leave the medical system largely in private hands. But they also agree that government must ensure that everyone has access to treatment while costs are restrained.
As the governors' draft proposal says: "Clearly the nation cannot sustain the current rate of growth in health care costs. If the system is expanded to include universal coverage without reform, the cost problems will be greatly exacerbated."
The governors learned an invaluable lesson about controlling costs in recent years. When Congress put cost controls on certain Medicare procedures, doctors and hospitals shifted the costs to those with private insurance.
In other words, if a medical procedure ordinarily costs $500, and Medicare pays only $400, then the price for those with private insurance becomes $600 - to make up the difference. The result: Prices keep going up.
The governors say that must stop. But the only way to do that is to bring everyone under a cost umbrella. Their draft plan would establish a "national health care board" which, with the states, would:
* Define a core package of benefits available to all.
* Eliminate tax deductions for any medical benefits not included in the core package.
* Develop a single claims form.
* Provide tort reform to cut down on excessive legal costs.
* Organize research to decide which medical procedures are effective, and which are not recommended.
* Establish state-run cooperatives through which medical insurance would be purchased.
* Make insurance portable for people who change jobs.
* Expand primary and preventive care, particularly prenatal and childhood care.
Although critics question whether an issue as complex as health care reform can be resolved within a few months, Romer calls it a must.
"If we fail [to move quickly], then it may not be done during the [next] four years," Romer says.
"There are going to be some very difficult decisions to be made here. And there is a new president. There is a new Congress. And I think there is a new awareness in this country that we need to bite that bullet. I'm advocating that we do it ... in depth in the first 100 days."