NEARLY everyone in Washington agrees that America's troubled health care system requires substantial reform. The three biggest problems: health costs are soaring, millions of uninsured Americans have difficulty gaining access to health care, and government and insurance programs for long-term custodial care are generally inadequate. But there agreement ends: There's nothing approaching consensus on what should be done to improve the situation.
Lack of consensus is particularly apparent among Senate Democrats. By this time a small group of Democratic senators who deal with health issues had been expected to present a comprehensive Democratic plan for health care reform to Senate Majority Leader George Mitchell, who had asked for it. The group includes Edward Kennedy of Massachusetts, David Pryor of Arkansas, Donald Riegle of Michigan, and John D. Rockefeller of West Virginia.
But they are nowhere near agreement. "We're all over the map" in ideas and proposals, admits one Senate source. Agreement appears weeks away, at least.
Difficulty in reaching Democratic consensus has important political as well as social repercussions. Democrats are trying to find some way to entice American voters back to their party and away from an enormously popular Republican president. "A lot of members are pinning their hopes on health care," says one Democratic source.
The longer it takes Democrats to draw up a plan, the less time they will have to use it to woo voters before the 1992 congressional and presidential elections. Already time is short, Democrats admit.
Among the possible reforms they are considering are: mandating health care insurance through employers, raising taxes to pay increasing health costs for government programs and the uninsured, and some form of national health insurance.
For every proposal there are both supporters and skeptics. For instance, in recent years, Senator Kennedy has pushed health insurance through employers; but Senator Pryor is deeply concerned about the resulting financial effect on small businesses.
"There's no way to design this bill that there aren't big problems," sighs one Senate source.
One problem: the memory of the short-lived catastrophic health bill. Enacted in the late 1980s, it was repealed a year later under pressure from affluent seniors who objected to paying higher Medicare premiums. The political heat members of Congress took for the original vote has made many leery of any major health care proposal, for fear that any change will produce more voter opposition than support.
Once Democrats agree on their proposal it will have to run a legislative and political gauntlet on Capitol Hill. Hearings likely will be lengthy and Republicans will have their own proposals. Congress may not be ready to vote on the issue this year, sources say.
The most likely scenario for passage of major health care reform this year or next is if President Bush makes the issue a priority and proposes or endorses a specific reform proposal that can win bipartisan support, some sources say. They point out that it was a presidential push, coupled with congressional Democratic leadership, that broke the logjam on environmental legislation last year.
Otherwise, major reform may not pass Congress until some specific proposal slowly obtains broad support from the business community, now under increasing financial pressure from the skyrocketing cost of premiums for employee health insurance. But that support could take several years to develop.
As an interim measure at least three members of the Senate are reported working on separate plans to reform health insurance for small business, to provide coverage for more Americans by ensuring that small companies can obtain affordable insurance for their employees.