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Published on 10/26/1998 All articles from this issue

Medicare conference draws huge crowd with myriad questions

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By Sandra Burnett

Special to the Town Crier

The future of Medicare could range from making it a government-operated health care system for everyone, to pushing it farther into the hands of for-profit health maintenance organizations, according to panelists at the first of 10 national seminars on the topic scheduled by the League of Women Voters.

Summaries of the seminars and another 300 "community dialogues" will go to a federal committee in January.

More than 250 persons attended the seminar, which was held Oct. 17, at the Stanford Linear Accelerator Center auditorium in Menlo Park. The program was funded by the Kaiser Family Foundation and was co-sponsored by numerous community-based organizations from Los Altos to Redwood City.

The question posed by the conference was: "Will Medicare still be there when baby boomers reach 65?" Baby Boomers is the term used to describe the large numbers of babies born during and after World War II, who are now in their 50s.

The panelists agreed that there is tension between the nation's desire for accessible, quality health care and the continuing reluctance to make the necessary trade-offs to achieve it.

Keynote speaker Thomas Bodenheimer, a clinical professor at the UCSF School of Medicine and frequent lecturer on health policy, called for increasing Medicare benefits to everyone, reducing out-of-pocket costs for beneficiaries and increasing covered services.

The trade-offs would be higher taxes and mandatory inclusion. "Budgeting the health care system works; other countries are doing it. But it requires that everyone in the country is in the same program; otherwise, costs are shifted from one program to another," he said.

But other speakers doubted whether such a system is realistic. Moderator Ian Morrison, chairman of the Health Futures Forum for Andersen Consulting, said that he's not convinced Americans will tolerate a "single payer system."

Sara Singer, executive director of the Center for Economic Policy at Stanford University, said that market forces "under a certain amount of government control is a more pragmatic scenario. "Raising taxes has been off the table every since I can remember," she said. "I believe market forces are a less painful way to achieve reductions in cost and improvements in quality than raising taxes."

Quentin Young, a practicing physician in internal medicine, president of the American Public Health Association and a Chicago radio talk show host, disagreed with Singer, who also happens to be his cousin. "The American people are hurting," he said, adding that "this crazy experiment with market forces" had led to widespread hardship.

"No other country dreamed you could get quality and access from the market place," he said, noting that 100,000 more Americans every day become uninsured. Both he and Melvin Britton, M.D., of the Palo Alto Medical Foundation, defended not-for-profit managed care.

Peter Van Etten, chief executive officer of the newly-combined UCSF-Stanford Health Care, doubted the viability of Dr. Bodenheimer's vision given the current public attitude of antagonism toward the government, but also downplayed market forces.

"The solution to Medicare is to design a broader system," he said. "I don't believe it can be done just through market forces. There has to be a balance between government control and market forces. It may not be possible to achieve in the current political climate."

Robert Sillen, executive director of the Santa Clara Valley Health and Hospital System, said Americans have no one to blame but themselves. "We have spineless leaders and that's because we have spineless constituents," he said, adding that the best way to health care reform may be campaign finance reform.