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Editorials
Wednesday, October 18, 2000Health-care
costs are expected
to increaseThe issue: The presidential candidates are proposing to add a prescription-drug benefit to Medicare.
THE presidential candidates are vying for the elderly's votes with competing plans to provide prescription drug benefits under Medicare. The problem of access to prescription drugs is a real one for retired persons. However, such pledges are bound to drive up Medicare's costs and worsen government's problems in finding the money to fund the program.
Meanwhile, the candidates aren't talking about the fact that the nation's already staggering health-care bill is about to increase dramatically.
A Congressional Quarterly report noted that in 1998, the last year for which official figures were available, the nation spent $1.1 trillion on health care. By 2008, the figure is expected to double. From 13.5 percent of the gross national product, health-care costs are expected to grow to 16.2 percent by 2008.
Private health insurance premiums are climbing again. This year monthly premiums for employer-sponsored insurance have increased an average of 8.3 percent, the largest increase since 1993. Last year the average increase was a more modest 4.8 percent.
Nearly two out of three Americans are insured through the workplace. Rising premiums may spur employers to cut back on workers' coverage or, in other states, even cancel it, although cancelation is not an option under Hawaii law.
Rising health-care costs also put pressure on Medicare and Medicaid. Medicare spending has increased from $148 billion in 1993 to a projected $244 billion this year. Federal, state and local Medicaid spending has increased from $121 billion in 1993 to a projected $193 billion this year.
With more expensive drugs and innovative medical technologies constantly being introduced, and with the aging of the baby boom generation, the signs point to even greater costs in coming years.
One answer to surging health-care costs was managed care. But restrictions imposed by managed-care plans to control costs have encountered resistance, resulting in attempts to pass a "Patients' Bill of Rights." The aim is to ease some of the cost-saving restrictions and give patients leverage to appeal when a health plan denied coverage. Obviously this would limit the effectiveness of cost control.
Robert Blendon, a professor of health policy at Harvard University, observed that "cost containment is very unpleasant. The containment is in the future, and the pain is in the present. It's very difficult to do unless there's a crisis."
The current budget surplus makes it possible for Al Gore and George W. Bush to talk about adding prescription drug benefits under Medicare as if the government can afford to fund these benefits. But the projected budget surpluses may not materialize, at least not in the magnitude envisioned. On the other hand, growth in the cost of health care in general and Medicare in particular is a virtual certainty -- an unpleasant fact that the candidates prefer to ignore while they talk about increasing benefits.
Kosovo separatism
THE toppling of Slobodan Milosevic from power in Yugoslavia does not necessarily mean an easing of tension in the war-ravaged Serbian province of Kosovo.
A significant number of the ethnic Albanian majority remain adamant --and militant -- in their desire for Kosovo independence. New Yugoslav President Vojislav Kostunica is just as unswerving in his allegiance to Serbian nationalism. NATO troops, including Americans, will be required to remain in the province to maintain a semblance of stability.
Kosovo became an international protectorate in June of last year following an 11-week NATO air campaign that halted a Milosevic-directed campaign of killings, rapes and forced expulsions of Albanians. Despite the presence of a NATO peacekeeping force of 39,900 -- including 5,700 Americans -- Kosovo officially remains part of Serbia, which, along with its smaller sister republic of Montenegro, comprises Yugoslavia.
Councils composed mainly of members of the disbanded Kosovo Liberation Army have been running Kosovo's municipal governments since the end of the NATO bombing. They will be replaced by officials to be elected later this month. NATO forces, known as KFOR, have been increased in anticipation of those elections. Kosovo Albanians also want to hold parliamentary elections within six months, followed by a vote on independence.
Kostunica is not likely to allow such an initiative. He opposed the NATO bombing last year and promised during this year's presidential campaign that he would insist that Kosovo remain part of Serbia. The West also opposes Kosovo's aspirations for independence, fearing further destabilization of the Balkans.
Milo Djukonovic, Montenegro's pro-West president, led a boycott of Yugoslavia's presidential election. However, Kostunica agreed this week with Montenegro's leaders that problems in its partnership with Serbia would be resolved peacefully and said he would respect any wish by its 640,000 inhabitants to secede from Yugoslavia. Milosevic had provoked fears of military action against Montenegro separatists.
In addition to engaging in the Montenegro talks, Kostunica has received numerous international officials and attended a European Union summit. Despite those encouraging signs of peace, NATO forces may need to remain in Kosovo while separatism remains an issue.
Published by Liberty Newspapers Limited PartnershipRupert E. Phillips, CEO
John M. Flanagan, Editor & Publisher
David Shapiro, Managing Editor
Diane Yukihiro Chang, Senior Editor & Editorial Page Editor
Frank Bridgewater & Michael Rovner, Assistant Managing Editors
A.A. Smyser, Contributing Editor
