Agenda for HHS
THE nomination of a new head of the Department of Health and Human Services is welcome news. The HHS department, with its $300 billion-plus budget -- larger than the entire gross national product of China -- touches the lives of too many Americans to go much longer without a Cabinet officer firmly in charge.
Dr. (and former Indiana Gov.) Otis R. Bowen comes highly recommended as an effective administrator and also an effective leader, with a ``common touch'' not unlike that of President Reagan himself. He is described as ``very conservative'' on social issues, including abortion, and hence on the White House wavelength, without being an ideologue. In confirmation hearings, the Senate will want to probe his views on sensitive policy issues.
For all the attention the department has received as a vehicle for carrying out the administration's social agenda, its real significance lies in the enormous programs of the Social Security Administration and the Health Care Finance Administration. These must continually be considered in terms of both their effectiveness and the federal budget deficit. Presumably ``Doc'' Bowen, as he is widely known, with his fiscal, as well as social conservatism, will be up to the task.
Bowen, a family physician straight out of a Norman Rockwell painting, would be the first doctor to head HHS. As a sexagenarian, he will have a useful perspective on issues affecting the elderly.
He also will presumably have an easier time of naming subordinates acceptable to the White House than did the departing secretary, Margaret M. Heckler, whose tenure was marred by a high rate of upper-echelon staff vacancies.
Some suggestions for an agenda for the new secretary:
Reform of the medicaid program. Observers on both sides of the political aisle see a need to provide more uniform benefits across the states. The working poor, in particular, have often slipped through this part of the safety net.
Another concern is that the low rate of reimbursement for physicians is causing them to refuse medicaid patients; this, in turn, diverts these patients to hospital emergency rooms for routine care -- at greater ultimate expense to the taxpayer.
The problem of long-term care for those elderly people either not sick enough or not poor enough to fit into existing programs must be addressed.
Medicare's distinctions between hospitalization insurance and insurance to cover physicians' fees, the so-called Parts A and B, need to be erased to allow more effective, and cost-effective, combinations of in- and outpatient service.
Cost containment is a continuing priority. A voucher system to increase competition and give people choices among care providers certainly bears study.
Total health-care spending in the US for 1984 rose a ``mere'' 9.1 percent over the year before, the smallest increase in two decades. A cost-containment mentality has taken hold. But long-term demographic and technological trends suggest that last year's modest increase may be just a brief plateau on a curve trending ever upward.