WASHINGTON - As members of the new Congress pack to come to Washington to be sworn in, one of the issues they are most worried about, after talking to the folks at home, is the deteriorating state of the nation's health-care system.
Doctors in West Virginia went on strike over soaring costs of malpractice insurance. Doctors in Pennsylvania threatened to do the same but now are waiting to see if the new governor keeps his promise to force health insurance companies to share some of the burden.
When the Senate's only surgeon, Dr. Bill Frist (R., Tenn.) came upon a fatal accident in Florida on New Year's Day and rendered medical assistance, the first thought many had about the incoming majority leader's good deed was whether the Samaritan might face potential liability.
Every month hundreds of thousands of Americans lose their health insurance - about 42 million have no insurance now and the number keeps rising. Parents cling to dead-end jobs they hate, terrified of losing even weak coverage for their children. Small employers say the cost of insurance is squeezing painfully and forcing layoffs.
Everybody knows somebody who is postponing surgery or doing without medication or refusing to see a doctor because of the cost. In sprawling Los Angeles, 73 percent of voters approved a hike in property taxes in a near-frantic effort to keep public hospitals open, strained to bursting because of 2.5 million uninsured residents.
There are many who hope that after years of national wrangling, this might be the session of Congress that carves out a solution. Senator Frist is eager to make his mark and heartened many when he told reporters last month, “We need to focus on the uninsured and those who suffer from health-care disparities that we so inadequately addressed in the past.”
Also, the Bush White House is already in full campaign mode for the re-election battle next year.
But with Mr. Bush arguing that an economic stimulus package (including more tax cuts) and less federal spending are needed to spur job creation, there is an enormous amount of skepticism that Congress actually will do anything meaningful, even now with many convinced this is a crisis. The states are in financial trouble, laying off thousands of employees, cutting health benefits for as many as a million more children and poor adults, and even emptying jails to try to stem red-ink spending.
And there's not much help coming from the feds - Washington is again posting deficits. With plans to spend as much as a billion dollars on smallpox vaccinations in the event of a terrorist attack, the Bush Administration already is siphoning off money from other public health-care programs.
Mr. Frist has suggested that he will push some form of prescription drug benefit for Medicare patients but has not yet spelled out how it would work or where the money would come from. Democrats probably will have to decide whether to go along with a plan they think is woefully inadequate or wait and hope angry voters elect a Democratic president in 2004. Even though they have lost control of the Senate and Republicans control both houses, Democrats have enough power to influence what legislation passes or is killed.
It was discouraging that in the most recent elections there was no serious discussion about specific plans on how to remedy the health-care situation. With Mr. Bush's power still peaking, his plans to limit malpractice awards to victims of bad medical care, provide tax breaks for those who have to buy costly monthly health insurance, and make bureaucratic changes in Medicare, adding some drug coverage for senior citizens, are ascendant.
Critics say the plans offer too little and won't really address the core problem - that better health care is too costly for many Americans to afford without rationing. National coverage as proposed by Al Gore is unpopular and considered too costly for the government to provide. In-between plans that might be made workable raise many questions, still unanswered, and, as a result, have too few supporters at this point.
Senator Frist and Mr. Bush have an awesome responsibility to work together to come up with something that has a solid chance of approval by Congress. It was often said of the eight years of the Clinton administration that an opportunity for serious change that would have helped many people was missed. More than war or tax cuts, whether there is more affordable, more available health care could decide the fate of the Bush Administration and how long many of those eager new faces stay in Congress.
Americans see that many other poorer countries offer their citizens better health care and are asking insistently, “Why not us?”