Rethinking Healthcare

It's a scene out of some ER soap opera. The trustees of the main Medicare trust fund gather round their operating table and declare their patient has only five years to live. Last year they gave it one year more than that.

This fiscal verdict - that Medicare is running at a deficit growing so fast that it will exhaust its reserve funds by the year 2001 - is no surprise. (See adjoining column, "What Medicare Reform Plan?") Any attentive American should long since have recognized that the rise in medical costs is outstripping the payroll-tax revenues used to run the vast government health insurance system for older Americans.

And this rush into red ink is occurring even before the baby boom population bulge hits retirement (and Medicare) age. The Medicare-eligible population will double between 2010 and 2030.

Logically, there are four ways that the red ink can be stanched: (1) raise payroll taxes; (2) cut benefits; (3) pay doctors and hospitals less; (4) make Americans healthier.

With some exceptions, far too little attention is paid to option 4. But let us start by examining the first three.

Option 1 seems simple. Its proponents recommend just a "slight adjustment" upward in the payroll tax. But this is misleading. The demographic deluge coming only a few years after 2001 means much larger tax increases would soon follow. Furthermore, Social Security will need similar repair not too long afterward. So a tax increase now would doubtless grow into a major double burden for the next generation.

Option 2 has been used by President Clinton to beat Republicans in Congress and scare today's Medicare recipients. If the threat of reduced benefits is that potent now, imagine its impact when boomers swell retirement numbers. That's particularly true since today's younger voters have tended to demand the most expensive mechanics of health care.

Option 3 has been, and will be, attacked by doctors, hospital administrators, and, increasingly, HMOs. They believe Medicare price ceilings already infringe on a free economy's supply-demand equation - not to mention traditionally high salaries.

When the White House was selling its doomed health-care program in 1993, it included some restrictions from options 2 and 3 to try to offset a huge expansion and complication of coverage. In the years since that failed plan, despite the rapidly growing need to reform Medicare financing, compromise has been driven out by partisan politics, primarily the president's switching of signals about what he would accept.

No three words seem more lethal in Washington than "blue ribbon commission." Commission reports usually gather dust in the back of file cabinets and archives. But this issue seems one best solved by a face-saving blue ribbon panel that can protect each side from charges of abandoning either older or younger Americans.

Part of the panel's job would lie in educating the public as it proceeds. That means it should avoid the kind of secretiveness and hauteur that poisoned the closed-door Ira Magaziner health-care task force.

And one more stipulation: Although any Medicare rescue panel would primarily deal with economic factors, it could benefit all citizens, and official Washington, if it also held hearings and spoke out on Option 4: helping Americans become healthier.

By far the best route to healthcare solvency is a healthier populace. We are not the first to note that in recent decades too many Americans have become drug dependent. Here we refer not to so-called hard drugs but to the vast proliferation of over-the-counter medicines and vitamin-pill nostrums. Much of this represents self-enslavement of the gotta-have-a-sleeping-pill, gotta-have-a-stimulant, gotta-have-an-appetite-suppressant lifestyle.

All too many people take this approach, or its non-drug relative - frantic exercise and fear-driven diets calculated to the last calorie - as a substitute for meaningful living. Such fixation on health mechanics can be hazardous to your well-being. It certainly hampers one's ability to live productively.

As we have noted before, the founder of this newspaper, Mary Baker Eddy, wrote much about the underlying meaning of health and the impact of prayer in bringing about a harmonious life. It's a theme increasingly explored by the medical community. In one cogent passage Mrs. Eddy cited liberty and joy as "strong promoters of health and happiness." That statement effectively covers the trio of ideals set forth for America by its founders: life, liberty, and the pursuit of happiness.

Slavery to constantly changing fads and thinly verified research findings (often countermanded not many months later) is not a prescription for a healthy pursuit of happiness.

Americans ought to start reviewing their approach to health now, before they encounter the fear tactics likely to crescendo when the population bulge further accelerates Medicare red ink. To do so would be healthy in every sense of the word.

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