Two years ago when Congress established the Pepper Commission, it members hoped it would recommend solutions to two major national health-care problems. But in its report, delivered last Friday, the Pepper Commission - named for its first chairman, the late Rep. Claude Pepper of Florida - split sharply (8 to 8) over how to deal with one problem, that of the uninsured, and less sharply (11 to 4) over long-term care. Mostly made up of members of Congress, the panel did not address the underlying question that is so important in Washington during this time of huge budget deficits: how to pay for its proposals. The commission estimated federal costs of its idea at $66 billion a year, plus costs to businesses of some $20 billion.
Reaction to the proposal has been as split as the commission members were. ``Once again politicians are proving that they can't say no to the elderly,'' says Douglas Besharov, a resident scholar at the American Enterprise Institute.
``The commission handled this issue in a logical way,'' rejoins Ronald Pollack, executive director of Families USA. ``They've put their vision forth and there's going to be a debate about it.'' Once America's leaders, and its population, decide what they want to do, Mr. Pollack adds, it then will be time to figure out how to pay for it.
Stark hits lack of funding options
One of the sharpest critics of the commission's report is Rep. Pete Stark (D) of California, a commission member and one of Congress's leading experts on health issues. Mr. Stark swiftly proclaimed the proposal ``dead,'' because it did not include a way to raise the forbidding sum of money.
That's a bipartisan criticism even among commission members: Rep. Willis Gradison (R) of Ohio quickly accused the commission of ``totally sidestepping the question of how to raise revenues.''
By contrast, the commission's chairman, Sen. Jay Rockefeller (D) of West Virginia, defended the approach of facing up to costs and problems. Taking a partial approach to solving health-care problems, he said, would not be honest with the American people.
No one is blaming Senator Rockefeller for the commission's failure to reach a broadly supported consensus on the uninsured: He is known in Washington as a patient listener whose natural inclination is to try to build a consensus.
The commission recommended that businesses be required to provide health insurance to their employees, with tax breaks available for small firms to ease their cost. The unemployed and poor would have insurance through a new federal program.
Subsidies for long-term care
On long-term care, the federal government would pay the costs of the first three months in a nursing home. Longer stays would be subsidized by the federal and state governments. Nursing-home residents would be allowed to keep more of their assets than in the past and still be eligible for these subsidies.
The commission proposal goes far beyond most previous congressional plans for dealing with either of the two problems: access to insurance and therefore health care, and long-term care. Several members of Congress, including Senate majority leader George Mitchell, author of a major long-term care proposal in 1988, had been waiting for the Pepper Commission recommendations before offering their own legislative proposals.
Given the cost estimated by the commission, no one knows how much of its recommendations they will incorporate into their proposals.