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Was '92 the "health care" election?

One year ago, in the aftermath of Harris Wofford's come-from behind victory in the race to fill the unexpired term of the late Senator John Heinz of Pennsylvania, pundits predicted that 1992 would be a watershed year for elections. Americans, fed up with the rising costs and variable quality of health care, supposedly would make their voting decisions based on the candidate who offered the most attractive health care reform. Nursing home care particularly was cited as an issue because campaign advertisements for Wofford and other candidates zeroed in on the burden imposed on middle class families in caring for their elderly parents.

The columnists turned out to be right, in a way. Election day polling found health care the third most frequently-mentioned topic of concern among voters ... although farless frequently-cited than jobs or taxes. One out of every five voters mentioned health care reform as an issue, and nearly 30% of the voters supporting Clinton mentioned it - but that also means that 7 out of 10 Clinton voters didn't mention health care when asked about the key issues of the election. Most of the candidates who won "open" seats in Congress included health care reform as part of their platform, but so did many of the candidates who lost.

Robert J. Blendon, chairman of the department of health policy and management at Harvard University, believes that President-elect Clinton has not been left with any clear mandate on health care reform. Speaking before the Annual Meeting of the American Public Health Association last month, Dr. Blendon said that focus groups used to study voter preferences immediately after the election found that any single form of health care reform will be opposed by most Americans. The focus groups found that voters don't trust the insurance industry, the health care industry, or the government. "What they want," said Blendon, "is an invisible plan in which Congress comes in one night to pass a reform bill and then government walks away and lets it run."

Blendon found that the same problem occurred when Americans were asked how a new health care reform should be financed. The focus groups wanted no increase in the deficit, only a minor increase in taxes, and no increase in the amount of money that businesses had to contribute toward health care. He reminded his audience of a U.S. health care proposal once satirically suggested by former Governor Jerry Brown of California: universal care of the highest possible quality ... financed by Germany.

Although health care cost containment might seem to be a less drastic solution, Blendon's focus groups found that American voters generally do not believe that costs have been driven by the demand for the latest advances in medical technology or the costs of regulations and paperwork. Instead, the voters studied in the groups "were lukewarm toward any proposal that didn't involve lynching a few doctors and executing some insurance industry executives."

In summary, Blendon said, the election really gave voters a choice between government doing "something" about health care and government insisting that any change occur within the private sector. Now that the voters vaguely have said they prefer government to do "something," it is not clear that they have given President-elect Bill Clinton enough of a mandate to do something that makes a difference.

Canadian System Advocates

Also Lose Ground in '92

While legislators who favor a "goslow" approach to health care reform may have been among the most visible targets of the election, the biggest losers may have been the supporters of a "single-payer," Canadian-style national health system. Congressman Marty Russo (D-Ill.), the most prominent supporter of such a system in the House, lost his seat in the primary election this summer. And another proponent,congressman Tom Downey (D-NY), was defeated for reelection in his Long Island district. Advocates for the single-payer approach now have turned to freshman Senator Paul Wellstone (D-MN) to provide leadership for government-financed national health insurance, but acknowledge that Russo's defeat represented a major set-back for the proposal. In 1991, Russo's attempt to legislate a Canadian-style program received fewer than 100 votes in the House.

Quayle's Last Gift to Nursing

Homes: Ending Prior


In the closing week of the election, nursing homes received a bonus from a surprising source: the much-maligned Vice President Dan Quayle. A press release from the American Health Care Association (AHCA), representing approximately 9,000 long-term care providers, reports that the Vice President used the occasion of a visit to a nursing home to promise a review of the regulation that Medicare patients cannot be reimbursed for skilled nursing care unless discharged from a hospitalization. This restriction is alleged to be responsible for many unnecessary hospital episodes. It also allegedly discriminates against patients with chronic conditions requiring repeated nursing home stays.

Quayle made the promise in his capacity as Chair of the President's Council on Competitiveness. The Council, whose primary purpose is to reduce the burden of regulations on private enterprise, has been a target for complaints of a pro-business tilt in the Bush Administration. In this case, however, Quayle's request for a review of the regulation has the support of many Democratic members of Congress, as well as the National Governors Association and the National Conference of State Legislatures.

It is unclear whether the election results will affect the Vice President's determination to use his last few weeks in office to address the issue. If no action is taken, it appears likely that legislation to eliminate the three-day minimum hospitalization requirement will be introduced in Congress in 1993.

VA Worries About LTC Costs

Leads to Health Study

The Department of Veterans Affairs, concerned about residential care costs for the hundreds of thousands of increasingly elderly veterans, has instituted a massive Medical Outcome Study (MOS) at its Center for Health Maintenance of Aging Veterans in Bedford, Massachusetts. Having started last February, the Bedford study will eventually follow-up on a sample of 2,500 veterans selected from 15,000 individuals who have been screened for hypertension, diabetes, chronic lung disease, musculoskeletal problems, and alcoholism. Under the direction of principal investigator Lewis Kazis, ScD, and study coordinator Dr. Katherine Skinner, the MOS team will examine the veterans' health-related quality of life and study how the delivery of ambulatory care services has affected their health outcomes.
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Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Stoil, Michael J.
Publication:Nursing Homes
Date:Nov 1, 1992
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