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Push for enlightened health policy.

* When the Clinton health plan faded, opinion writers lost the thread. Let's get fired up again: We face more to be done.

Lots of voices are missing from the health care debate today, and increasingly one of them is our own.

Four years ago, opinion page editors and writers were fired up about the needs of the country's 37 million uninsured citizens and were advocating change. We helped lead the most vigorous discussion about health care in American history.

Regrettably, when President Clinton's plan faded our passion fizzled too. Feeling beleaguered and overwhelmed, we quietly let health care slip from the public agenda.

Let's get it back on. Much needs to be done.

Americans have lost sight of the notion that instead of using inflated insurance premiums to address human health needs, we could use tax dollars. Somewhere along the line, the idea that offering basic health care is a moral duty - just as providing education and public safety are moral responsibilities - morphed into a curious new manifesto: We must not harm the Insurance Industry.

Our editorial sins of omission were especially glaring last spring when Congress deliberated the Kassebaum/Kennedy Health Coverage Act. While that legislation wasn't nearly as sweeping as President Clinton's plan, it represented the country's best chance in 1996 at meaningful health insurance reform.

But readers wouldn't know that from looking at many editorial pages.

Kassebaum/Kennedy broadened access to insurance in a variety of ways, albeit only for people who could afford to buy policies.

It also mandates major changes in data collection that almost certainly will threaten the privacy of individuals' medical records. It could have required insurers to provide the same benefits for mental illness that they offer for physical illness, which would have revolutionized this country's response to mental illness.

Instead of leading the public debate about those changes, however, opinion page writers either ducked or got stuck on a side-issue: medical spending accounts.

Shame on us.

The goal of enlightened health policy is to protect and promote the well-being of individuals and communities. As opinion leaders, we must use our pages to help promote sound health policy. We can do this by examining public health needs, evaluating proposed changes, and balancing human burdens with costs.

Simply put, it's our job to increase awareness, analyze, correct misunderstandings, advocate, criticize, and help develop consensus.

Invigorate the debate

By writing a column about key issues in health policy for The Courier-Journal's opinion page, I'm helping to invigorate the debate. To aid you in doing the same, I've drafted a list of ten trends in health care. By keeping the political and social landscape in mind, the relevance of local and national news becomes plainer.

Admittedly, mine is a rather gloomy forecast, and I'm fully aware that marvelous shifts are occurring in health care: Some diseases are being wiped out; babies are born healthier; people with AIDS live longer and better. However, the over-arching trend is that the nation's health-care safety net is unraveling, and that poses a great threat to poor and middle-income Americans.

Suspecting that I am not the only pundit who occasionally feels baffled by health-related developments, I raided some Rolodexes and am supplementing the list of trends with a basic Health Source List.

This forecast was developed with the assistance of several excellent thinkers: professor Robert Blendon from Harvard School of Public Health, Robert A. Dorwart of Harvard Medical School's department of psychiatry, psychiatrist and Harvard educator Dr. Miles F. Shore, and ethicists Suzanne Holland and Daniel Callahan. She teaches at the University of Puget Sound in Seattle; he founded The Hastings Center.

RELATED ARTICLE: Emerging health care trends

1) The debate about physician-assisted suicide will turn into a broad-based quest to "die well" and control death.

2) The stampede to move Medicare and Medicaid recipients into managed care will threaten local safety nets, including health departments. Some medical schools and many public hospitals will fold.

3) A crisis really exists in Medicare. Americans must come to grips with the tension between costs and the demands for services for the program to remain solvent in the 21st century.

4) Efforts to control costs by getting patients into HMOs and other forms of managed care will intensify. Consumer concerns about quality of care will escalate. Expect increased pressure on states to address those concerns and intense lobbying efforts to defeat proposed legislation. More than 1,000 such bills were introduced in statehouses in 1996, and almost none became law.

5) Scientists will identify more ways to improve health by altering lifestyles and the environment. Here again, special-interest groups will thwart progressive legislation.

6) Advances in genetic knowledge will offer ways to enhance human well-being. They also will further commercialize life and produce new avenues of discrimination based on people's vulnerability to specific diseases, such as cancer and dementia.

7) Concern about protecting privacy will make patients reluctant to share information with therapists, nurses, and physicians.

8) Scientists will discover more ways to ease the misery of incurable diseases such as AIDS, but sick people won't be able to pay for the treatment.

9) The emergence of new drugs will bring vexing new questions regarding abortion.

10) Mothers and fathers going to bat for their sick children will promote progressive reform.

These are just some of the health issues on the horizon. As opinion leaders we have challenging, important work to do.

We must offer our readers informed commentary and enlightened opinions about health policy.

- Laurel Shackelford

NCEW member Laurel Shackelford is an editorial writer and columnist for The Courier-Journal in Louisville. Her column focuses on problems and opportunities in health care.
COPYRIGHT 1996 National Conference of Editorial Writers
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1996, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:includes related article on the emerging health care trends
Author:Shackelford, Laurel
Publication:The Masthead
Date:Dec 22, 1996
Previous Article:A field guide to the op-ed war zone.
Next Article:Editorial excellence: a sampling.

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