NATIONAL SYSTEM: Complex Necessity or Proven Failure?

      Syndicated columnist E.J. Dionne and Newsday's James Pinkerton each examine the need for a national health care system this week, both predicting that the issue will receive increasing attention as the number of uninsured Americans rises but differing on whether such interest is a good thing. Dionne suggests that the mixed success of the Children's Health Insurance Program (CHIP) means "we're learning a lot about what works and, alas, what doesn't" in helping states cope with the uninsured, pointing to Rhode Island -- which has cut its uninsured ranks by 12,000 -- as an example of how state programs can successfully help "those who would otherwise fall through the cracks of the health system." But CHIP has also failed to catch on in other states, Dionne notes, adding that another solution, touted by the New America Foundation, might be to create a federal program, modeled after Medicare, to give universal coverage to children. "The lesson from the failure of the Clinton plan is not that achieving universal coverage is impossible. It is complicated. ... Trial and error is the best we'll do. But we won't even get that far if we don't start trying again" ( San Francisco Chronicle, 8/13).

'The Worst Outcome of All'
      Pinkerton asserts that "the era of the HMO is coming to an end," as enrollment falls and premiums rise beyond the reach of many. But, he says, "if HMO coverage is bad, no coverage is worse. And a government takeover of all health care, still the enduring dream of many, would be the worst outcome of all." Pinkerton blames the rise in premiums on the increasing number of regulations being placed on HMOs, in addition to the cost of malpractice litigation and product-liability suits. Pointing to a July 14 JAMA article authored by members of Physicians for a National Health Program and Sidney Wolfe of the Public Citizen Health Research Group, Pinkerton derides the authors for describing "the present system as 'a failure' without once mentioning the legal and political factors that are causing it to fail" (Newsday, 8/12).

The Vouchers Have It
      Pinkerton and Dionne do agree on one possible fix to the current health system: using vouchers or tax credits to allow the uninsured to buy coverage. Pinkerton argues that such a move would "empower all Americans to seek out the best deal on health care," but predicts that "the media, always inclined toward grandiose initiatives, are likely to dismiss such ideas as too free-marketly simple" (Newsday, 8/12). Dionne, however, suggests the voucher approach represents a compromise solution, calling it a good way to "harness a conservative idea ... to a traditionally liberal purpose" (San Francisco Chronicle, 8/13).