Aug. 25, 2000 (Washington) -- I predicted at the start of the year that Congress would not enact any significant health care legislation this year. While there is still time for Congress to prove me wrong, I think my prediction will hold up.
The question is, why?
It's not as if our health care system is perfect. The news wires have been filled this past year with stories about seniors needing help to pay for prescription drugs, about people whose HMOs are callous, or about the high number of people without health insurance.
But from Washington there's only been rhetoric and political accusations, which will increase as Election Day nears.
In my view, there are three fundamental reasons why the Republican Congress and the Democratic administration have failed to pass major health care legislation:
- Political partisanship is at its worst ever. Listen carefully to what the politicians are saying. They attack each other rather than advance solutions of their own. Neither party is willing to share with the other -- or with a lame duck president -- the credit for legislative achievements. There are no leaders who are willing to set aside partisanship. The Republicans are just as intent in denying President Clinton a solid legislative legacy as he is in seeking one. I'm not alone in saying that partisanship in Washington has reached an unprecedented height.
- There are too many health care issues that need to be addressed, and therefore there is no focus. Seniors seek prescription drug coverage under Medicare. The rights of patients and physicians to deal with the arbitrariness of HMOs needs to be addressed. Medicare needs to be reformed to reflect current medical practice. We need to make it easier for the 40 million uninsured Americans to get reliable medical treatment, and not just in emergency rooms.
A survey taken by the Washington Post found that there are six health care issues on the public's mind, in this order: Medicare financial security, health insurance for more people, patients' rights under HMOs, helping seniors pay for medicines, price controls over drugs, and helping care for the elderly or disabled.
But only 20% of the public believe that the top issue, assuring Medicare's financial stability, is "most important." Congress can't deal with all these issues at once, especially when none stands out as most critical, so it's become paralyzed and unable to do anything. Historically, the smart political leaders have succeeded by focusing on a single issue at a time. That's not happening nowadays.
- The public momentum for change has waned. Even though some political polls show that prescription drug coverage is a priority for elderly voters and will be a central issue in some congressional elections, overall the public no longer regards health care reform as a top government priority. A study recently published in the journal Health Affairs found that, in April 2000, only 15% of Americans thought health care should be a top government priority. That compares with 55% 1994. Without public clamor, there is not enough incentive for Congress to act.
Is there any hope for change? The answer is a resounding yes. The start of a new presidential administration usually is an opportune time for the enactment of significant legislation. Regardless of who the next president is, he will be experienced in how the legislative cycle works and hopefully will seize the opportunity to provide leadership.
On the other hand, legislation passes more easily when the same party controls the White House and Congress. It is unclear which party will be in charge in Washington next year -- and whichever one is in control of Congress and the White House, it won't be with an overwhelming mandate from voters.
The presidential election is expected to be very close. The House, now controlled by Republicans, could go either way. The Senate is likely to remain in the control of Republicans, but by a narrow margin.
Voters who are concerned about health care issues can influence the politicians most effectively during the election campaign. If you think change is needed, between now and November is the best time to communicate that to the candidates of your choice. If you don't speak up, then the next Congress will be a repeat of this one -- without any legislative changes in how our health care system works.
Wayne L. Pines, WebMD's Washington columnist, is a former Associate Commissioner and Chief Spokesman of the Food and Drug Administration. The opinions expressed in this article are not necessarily those of WebMD.