Enacting sweeping health-care reforms is a hot topic in the nation’s capital, but Congress should think twice before imposing wholesale change on the rest of the country.

We in Washington state have direct and unpleasant experience with what happens when starry-eyed government leaders decide to enact radical reforms that go in the wrong direction. The result can be described in three little words: It didn’t work.

Ten years ago, as the nation was rejecting Hillary Clinton’s much-vaunted health-care reforms, elected leaders in Washington state decided to press ahead with their own plan. With ringing fanfare and heady optimism our legislature passed, and then-Gov. Mike Lowry enthusiastically signed, the most extensive state health-care program in our history.

The idea was to get comprehensive reform started in a few states – Washington had the misfortune to be selected – and then expand it nationwide. The state plan contained all the elements of the Clinton proposal. It created higher taxes, expanded health-care regulation, added more mandates on employers and individuals, determined what services patients could receive, required all citizens to participate and, to manage it all, established a new centralized bureaucracy.

A new era was dawning. By legal fiat we would have affordable, high-quality health care for everyone. It was going to be wonderful. Then reality struck. Within a few years costs were soaring and a record number of health insurers had left the state. The individual insurance market collapsed, and the uninsured population ended up higher than when the program started. It quickly dawned on legislators that they had made a mistake. By the mid-1990s they had repealed the broadest reforms and in 2000 passed legislation to resuscitate the individual market, which is gradually recovering.

Congress is now considering what approach to take to health-care reform. What is needed is not sweeping, politically driven change but steady progress toward broadening health coverage for all Americans. There are proven, common-sense reforms Congress can enact that would move the nation in the right direction.

As a start Congress should set up a review commission to study the cost impact of mandates. Government policies often remain in place long after they have served their original purpose. For example, in 1963 Washington state had a single health mandate. Today it has 43, meaning consumers are being forced to pay to cover dozens of medical services they don’t want or need.

A comprehensive review would inform Congress about which mandates have become counter-productive and which should be retained. Next, Congress should reduce the number and complexity of federal rules that limit the kind of insurance that can be sold to the public. By eliminating low-priced alternatives in the marketplace, regulations make it illegal for people to buy basic health insurance. It is like a hotel market with plenty of Hiltons and Sheratons, but no Motel 6.

Congress should also encourage employers to offer individual health accounts. The money in the account would belong to the worker personally, would accumulate from year to year and would go with the worker when he changed jobs. Portable individual accounts would empower health consumers to do something most of us can’t do under the current system; shop for health care based on quality and price.

Members of Congress should learn Washington state’s hard-won lesson and avoid the kind of blanket, utopian reforms that are likely to do more harm than good. Lawmakers should instead focus on incremental steps that give individuals, not government officials, more control over health coverage, and which reduce the cost and broaden the choice of private health insurance for everyone.



ABOUT THE WRITER

Paul Guppy is vice president for research at the Washington Policy Center, an independent, nonpartisan research and education organization, www.washingtonpolicy.org. Readers may write to him at WPC, P.O. Box 3643, Seattle, Wash. 98124-3643.

This essay is available to Knight Ridder/Tribune News Service subscribers. Knight Ridder/Tribune did not subsidize the writing of this column; the opinions are those of the writer and do not necessarily represent the views of Knight Ridder/Tribune or its editors.



(c) 2003, Washington Policy Center

Distributed by Knight Ridder/Tribune Information Services

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GRAPHIC (from KRT Graphics, 202-383-6064): health

AP-NY-03-06-03 0610EST


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