WIU PROFESSOR RESPONDS TO
HEALTH CARE REFORM PROPOSALS

By LaVONNE STRAUB

The various health care plans being used as part of campaign platform of candidates for Congress and the Presidency have one Western Illinois University professor concerned.

"The current health care system does need some reforms," said Dr. LaVonne Straub, professor of economics and associate of the Illinois Institute for Rural Affairs, whose area of expertise is health care, particularly rural health care. "However, the President and Congress must look very carefully at the long-term economic implications of the initiatives, as well as the effect of reform on the quality of health care. Legislation on this very complex issue should not be passed only because it is an election year."

Straub believes that Congress should carefully review the problems facing other health care systems, especially universal coverage, prior to considering any as a model for the U.S. The Canadian system is frequently used for comparison; however, it is under stress to serve all those who need care. There are indications that some health care professionals from that system, as well as those seeking specialty care, are coming to the United States.

Redesigning the U.S. system is hindered by a problem not faced by others; that is we have the top medical specialists, facilities, and equipment in the world.

"Americans are accustomed to this as the standard of care," said Straub. "Even though it is not available to everyone, a large segment of the population has good access. What is necessary (but difficult for politicians) is honesty about the difficulty of providing that standard of care for all, without facing yet higher costs of health care and, ultimately, giving up other desired goods and services. Thus, a reshaping of our expectations, and of our system is needed; with more flexibility, such that quality care is focused more on primary, preventive care — and on more personal responsibility for health outcomes.

"I believe, as most Americans do, that basic health care should be available to all. However, under a universal health care plan, Americans may find themselves waiting longer for care than many are used to, and some services may have to be given up." Straub says that most of the plans currently being proposed, such as "play or pay," which mandate employers to supply coverage or pay into a pool, will ultimately be paid by workers and taxpayers. "Employers will pass on the cost of health care to employees through less growth in wages and benefits, and onto consumers in the form of higher prices for goods and services," she said. "The plans are a form of income redistribution; many of the proposals represent hidden taxes, which are basically regressive, placing more burden on low- and middle-income workers."

A concern not being addressed in most plans is the supply side of the health care market, according to Straub. "If Congress places price controls on medical providers, what will happen to availability and quality of care?"

Straub believes that one of the reasons for difficulty in retention of providers in rural areas is the inequity in payment; it is not clear how caps on payments will motivate more resources to practice. Those proposing plans have not addressed the supply issue and what incentives will be present to motivate new entry into health professions and continued innovation and medical research.

Straub also points out that "one reason this country has experienced such growth in health care providers and facilities is due to generous and growing returns to those resources. It is likely that with caps on that reimbursement, the supply side will respond differently; along with the expected response of greater demand with universal coverage, a sizable gap in availability of services is likely to result."

At this point Straub is suggesting more honesty about who is really going to pay for expanded health coverage when politicians indicate it is "government and employers!" And, more honesty about what should be anticipated about the future supply of health care. •

March 1992 / Illinois Municipal Review / Page 5