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Response to Scott M. Matheson Stanley B. Jones Stan Jones in his verbal remarks spoke to the issue of health care as a right and Governor Matheson's observation that the federal govern- ment at this time was "incapacitated" to play the required key role in this area given the fiscal crisis and a general lack of leadership in shaping a national social agenda. He observed that people in our society today feel less confident about the future than in years past and seem less inclined to look out for their brethren. Employers are worried about their labor markets, the rising costs of doing business, and competitiveness in the world market. In the fast-growing service industries, employers find that it is not always necessary to provide health insurance coverage. Providers appear more comfortable with add-ons in technology and sophisticated procedures than in extending access to primary or preventive care. Insurers, in this more competitive environment, are looking for profitable and self- supporting markets, not markets that are risky or economically mar- ginal. Insured individuals want the best deal for their premiums. It is not clear that we really want to provide universal access to health care. In addition, what we have already costs too much. Our health care institutions feed on growth. Even slowing down or stabilizing is viewed as destructive to the basic economic fiber of the system. In this context, 28
changing demographics and future liabilities take on a frightening specter. A sense of scarcity, the reality of a shrinking pie with growing demands, are making people want to hold on to what they have and not to let anything be taken away. A major question then is, how do we break through this fearful, protective mind-set? How do we begin to build a consensus for extend- ing access to health care to the less fortunate in our country? What values do we appeal to in our electorate and in our health care institu- tions? The political base at both the federal and state levels required to break through the current impasse is not evident. Governor Matheson linked the need to expand access with a need to spend existing health care dollars more judiciously. But how do we develop the political power base to reallocate our existing resources more appropriately and effectively? In the Congress it is increasingly difficult to make even minor changes in current programs, given the many powerful stakeholders whose livelihoods may be affected. How might even a repaired federal government raise the revenues to finance universal access? Raising taxes is not a viable option. Revenue enhancements cannot raise the level of funding required. Employer or state mandates remain controversial options; many per- ceive such strategies as taxes in disguise. Income-related premiums, requiring economically better-off citizens to finance a new social benefit is an approach that we are testing in the recently enacted Medicare catastrophic coverage law. Whether that approach will work remains to be seen. Thus, the question that we must ask ourselves is, how can we marshall the leadership, the political power base to make funding for enhanced access a higher priority on our national agenda? Clearly, addressing the problem of access will require a more equitable and potent federal-state-private sector partnership. Building a consensus, developing a feasible strategy with committed, broad-based support remains a critical challenge. We might begin by asking those in our audience, who represent so many of the key players in this arena, what they might offer in this process. 29
