Spring 2001; Volume 2, Number 1
As the new administration and Congress now face the task of drafting healthcare legislation, it is interesting to speculate how, or if, the political calculus has changed since the Presidential campaign. In our Fall 2000 issue, we focused on the healthcare proposals made by the two major candidates. Since it is often said that "campaign promises are made to be broken," one need not be overly cynical to ask to what extent those positions reflected the immediate need to win votes, rather than deeply held convictions. Now that the election is over, will there be changes in the landscape, as actual legislation is developed?
Since legislation, once signed into law, has real-life consequences for all Americans, one would hope that objective merit would prevail over short-term political advantage in the legislative drafting process. The reality, of course, is that political calculations are never off the table. Terry McAuliffe's remarks, upon being chosen Chairman of the Democratic National Committee, are a useful reminder that practical strategies for winning the 2002 Congressional elections are already being considered. Both parties will, at least in part, view any significant legislative proposal from a political perspective.
Further complicating matters, the dividing line between objective merit and political motivation is often hard to discern. Since reasonable minds can disagree on the most effective means to achieve any given end, where does objectivity end and political expediency begin when, for example, one tries to define the roles that government bureaucracies, third-party payers, drug companies, physicians, and patients themselves should play in making healthcare delivery decisions?
Questions such as these will abound as Congress turns its attention to the subject we have chosen as the theme for our Spring 2001 issue: Medicare and the adequacy of healthcare services for our senior citizens. This topic received much attention during the election and remains politically sensitive. Although both the Bush and the Gore campaigns argued that Medicare needs a major overhaul, some experts question the very premise of this debate, arguing that the current system works extremely well. One of these experts is Dr. Bruce Vladeck, former Administrator of the Health Care Financing Administration (HCFA) from 1993 to 1997, who opens our Symposium on this subject with an emphatic defense of the current model. Based on Vladeck's analysis, one could conceivably speculate that the whole subject of Medicare reform was instigated simply to attract senior-citizen votes. On the other hand, responses to Vladeck's analysis are offered by Dr. Marsha Gold of Mathematica Policy Research in Washington, D.C. and by Dr. Harry Cain, former Executive Vice President of the Blue Cross and Blue Shield Association. Gold examines Medicare from the perspective of its beneficiaries, while Cain directly challenges Vladeck's defense of Medicare, arguing that "Medicare as currently operating is a menace to the future of health care in this country."
Our Spring issue also discusses other topics of concern to our nation's growing population of senior citizens. Nancy-Ann Min DeParle, the HCFA Administrator from 1997 to 2000, and John Rother, Director of Legislation and Public Policy for the American Association of Retired Persons (AARP), contribute their perspectives on the state of health care for the elderly. Separate articles address such topics as the quality of nursing homes, long-term care and the Program for All-inclusive Care for the Elderly (PACE).
In addition to our central theme, this issue of HHPR contains papers on a variety of topical subjects by recognized experts and by graduate and undergraduate students. For example, the problem of the uninsured is described in an article by Professor Uwe Reinhardt of Princeton University. The American response to foreign health systems is examined in an article by Harvard Professor Robert Blendon and Minah Kim. An interesting picture of the health care challenges facing developing countries is presented in a paper on the current state of pulmonary health care in Tibet. Articles on the anti-smoking movement and stem cell research in the United States are also included. The national interest in these last two topics was emphasized by the prominent roles they played in the January confirmation hearings of Wisconsin Governor Tommy Thompson to be the new Secretary of Health and Human Services.
A final note: the staff of the HHPR is deeply grateful for the many readers who were prompted by our first issue to submit comments. This response has confirmed our belief that many people on and off the Harvard campus are interested in better understanding health policy issues. We plan to institute a "Letters to the Editor" feature in our Fall 2001 issue. If you have a reaction to any of the articles published in HHPR, or if you would like to learn about health policy issues not yet covered by HHPR, we would appreciate hearing from you.Clay Ackerly
about us | links | contact us | subscribe | epihc