Health care policy analysts who met last month expressed gratitude for only
one aspect of the election—they weren't still in suspense about the
At the Grantmakers in Health (GIH) Fall Forum, Robert Reischauer, president
of the Urban Institute, described a bleak context for a subsequent panel
discussion titled "The 2004 Election: What Do the Results Mean for
Health and Health Care?"
GIH is a nonprofit organization that educates grant-making entities such as
foundations about the relevance of public policy to their work and raises
awareness among policymakers about health philanthropy.
Reischauer began by charging that in terms of health care, "neither
[candidate] was willing to confront the fiscal constraints that are going to
face the next president and policymakers at the state and local
He added that the disconnect is most acute in the area of health care,
where "almost all of the solutions to pressing problems cost huge
amounts of money."
Reischauer offered attendees an encapsulated version of "how we got
into the current predicament that we're in" in terms of financial
In January 2001, the federal budget showed a surplus of $236 billion. By
2004, the federal budget deficit was $413 billion, a record for the
Among the factors contributing to the change were federal tax cuts, the
economic "downturn," and increased spending on defense.
Reischauer then offered a glimmer of good news before adding new details to
his discouraging portrait of the future.
He said that the seriousness of a deficit should be considered in relation
to the size of the overall economy. Although when measured in dollars, the
current deficit is the largest in history, deficits in the early 1990s were
larger in proportion to the gross domestic product.
Addressing the current deficit, however, will be particularly difficult
because the retirement of the baby-boom generation is "staring us in the
face." They will begin to collect Social Security and Medicare benefits
and likely will also form a powerful voting block that complicates the
prospects of change to those programs.
What do budget deficits have to do with the prospects for health care
reform? "The simple answer to that [question] is `a great deal,'"
He pointed out that the country's willingness to address such problems as
the growing number of uninsured and prescription-drug insurance coverage will
be constrained by fiscal problems.
In addition, health programs already account for about 25 percent of the
federal budget, and their budgetary significance is expected to grow.
Projected growth in Medicare assumes seven annual cuts of 5 percent in
physician payments starting in 2006, an event that Reischauer said "will
Reischauer concluded by saying that "the collision between health
policy and fiscal constraints is likely to be most evident in the area of new
Jackie Judd, vice president of the Kaiser Foundation and moderator of the
subsequent panel, opened by saying, "Health care never really made it
into the first tier of issues voters said they were interested in."
Peter Harkness, editor and publisher of Governing magazine,
agreed, saying that health care was "way down the list."
Thomas Mann, senior fellow at the Brookings Institution, told the audience
that President George W. Bush claims a mandate for his view that social
insurance programs, such as Medicare, should be transformed to make
individuals more responsible for their retirement and health insurance.
Rebecca Adams, a reporter for Congressional Quarterly, listed
medical malpractice reform, health care tax credits, and conversion of
Medicaid into a block-grant program as initiatives Bush would likely push. She
added that the increasing cost of long-term care is a major problem for
Medicaid, but likely would not be addressed.
Harkness said that increasingly health policy is not being made at the
federal level and is "sent down" to the states as much as it is
made at the state level and sent up.
California, for example, passed ballot initiatives supporting the
development of stem-cell research and providing increased funding for mental
health. Minnesota initiated the first state-sponsored Internet site that
enables residents to purchase drugs from Canada. Both states have Republican
governors, Harkness noted.
Transcripts of "Setting the Context" and "The 2004
Election: What Do the Results Mean for Health and Health Care?," are