Prescription for disaster

Dr. Alieta Eck knows better than to treat the symptoms but not the ailment. It's a snowy April morning when 3-year-old Lydia comes into the study in tears. Her physician mother carefully examines the knee she points to, making medical-sounding noises, and finally administering an emergency kiss to the spot. That does the trick; Lydia ambles from the room without a limp or a care.

Later in the day, this 44-year-old New Jersey doctor is at the office she shares with her husband and their two partners. A graduate student from nearby Rutgers University has come in, complaining of depression, of an inability to concentrate or sleep well. He comes from a Muslim background, but he's an atheist. Again, Dr. Eck seems to see past the symptoms. There's little she can do medically, but she takes the time to talk with him about God. His response is encouraging: You can't study biochemistry for long without seeing the hand of someone, he says.

"I'm going to watch this fellow," she says later. "What he needs is available, and God directed him to our office as part of his design." She wants to be involved in his cure, she says, not just in soothing the symptoms of a life without Christ.

The prognosis in another case she's been watching isn't quite so optimistic: Given her penchant for treating the real ailment, Dr. Eck sees little hope in Washington's cure for the American health care mess. She fears that the bills currently under consideration will merely stick a Band-Aid on a system that looks terminal.

Since burying the president's massive, intrusive health plan, Republicans in Congress have been promising "market-based" health care reforms of their own. Just prior to the Easter recess, the House passed a bill that included three items ranked high on conservatives' wish list:

Medical Savings Accounts (MSAs), a type of group policy that encourages spending restraint by creating a health care "bank account" that individuals draw on as needed. At year's end, the excess in the account typically may be rolled over, withdrawn, or transferred to a retirement account.

Portability provisions, which guarantee that anyone who has been covered for 18 months under an employer's health plan can automatically qualify for coverage when changing jobs, with no waiting period. Supporters say portability will offer relief to the 25 million Americans who feel "job locked" because they fear losing health benefits if they change employers.

Increased health insurance deductions for the self-employed, a provision that encourages entrepreneurship and allows individuals to compete on a more level playing field.

House members admit, however, that the chances are slim for such market-based reforms. The culprit is Kassebaum/Kennedy, the Senate's watered-down version of health reform, which includes neither MSAs nor increased deductions for the self-employed.

Sen. Nancy Kassebaum (R-Kan.) says she is personally in favor of MSAs but wants to present the president with some kind of incremental health reform that he will sign-something he has promised not to do with any bill that includes MSAs. It's likely the more constructive provisions in the House bill will be stripped from any reconciled bill that emerges from a House/Senate conference committee. House Speaker Newt Gingrich has all but conceded defeat; after the House bill was passed, he announced his willingness to strike the reform provisions to get a bill Mr. Clinton would sign.

"We're in a very difficult position," admits Bob Inglis (R-S.C.), a co-sponsor of the House bill. "Frankly, what we need is a new president. The whole of what we're trying to do is being stopped by Bill Clinton, the last, best defender of big government.... We're searching for the least common denominator in health care. In this case, that's a reasonably good package that unfortunately doesn't address the fundamental need for reform."

While Republicans in Washington review applications for a new president, many outside the Beltway are getting impatient. A number of states have implemented their own health care reform plans-mostly with dismal results. State plans generally include some form of "guaranteed issue," which requires insurance companies to write policies for all applicants, regardless of factors such as pre-existing medical conditions.

Critics say that's paramount to driving without insurance, then picking up the cellular phone to order a policy right after totaling the car. The Wall Street Journal reported that one mother in Washington, a state with guaranteed-issue laws, wrote to Blue Cross thanking them for their excellent maternity coverage. She then cancelled her policy because she had had her baby, but assured the company that she would be back if she ever became pregnant again.

Such on-again, off-again coverage is typical of states that require guaranteed issue, and it can have a devastating impact on insurance rates. With insurance available at any time, healthy young people drop out of the insurance pool to save on premiums. That leaves the system top-heavy with older policyholders who have higher medical bills. To cover those bills, rates are increased, which causes even more young people to cancel their policies. In New York, which rewrote its health care laws in 1993, 350,000 people dropped out of the system in a single year as premiums soared, and the average age of policyholders increased by 3.5 years, according to the Council for Affordable Health Insurance, a coalition of smaller insurers.

Dr. Eck has seen the problem firsthand in her home state. New Jersey recently implemented guaranteed issue, and initially everyone seemed happy; even the insurance companies supported the reform. Before long, however, rates began going up. Now the insurance companies are hard-pressed to cover everyone, and there's talk of an outright government takeover of the industry.

"Medicine costs money," Dr. Eck says. "The costs will not come down until people start thinking about that, and making thoughtful choices about their own care." She believes Medical Savings Accounts are the key to that change in thinking. Because consumers under an MSA plan are in effect spending their own money (usually contributed in part by their employer), they tend to be much more frugal and price-sensitive. If a faraway insurance company is paying the bills with money that never passes through the consumer's hands, there's little incentive to economize. To the consumer, treatment is "free"; it's the employer who feels the pain of spiraling insurance premiums.

Rep. Inglis agrees that MSAs are vital. "I think it's very important to approve MSAs and get reform going," he says. "People are growing uncomfortable with the concept of managed care because they see that their choices are limited. MSAs help put them back in charge of their health care choices."

So why would anyone be opposed to that? Mr. Inglis has a simple answer. "MSAs offer no role for government; it's a purely market-based concept. This president loves the government and wants to grow it at every opportunity. That's why he and Mrs. Clinton hate the concept."

While Washington fiddles, however, there is action outside the Beltway. Even without the tax benefits that Washington's blessing would bring, many companies have realized the potential of MSAs, and hundreds of thousands of employees are already covered under health plans that include savings accounts.

Dr. Eck and her husband, also a physician, are mulling over an innovation of their own. Some churches and individual Christians have expressed interest in establishing a model MSA that's administered through a church rather than an employer. "If a family puts in $4,000 per year," Dr. Eck projects, "then the church could manage it. If they needed it for health care, it's there, but if not, at the end of the year it's a charitable deduction." Any extraordinary health care expenses above the amount that a member contributed to the MSA would be covered by a catastrophic insurance policy, which costs much less than full insurance coverage.

There are questions, of course, as to whether such an activity would distract the attention of some churches from their central activity of worship, preaching, and teaching. Dr. Eck, however, believes the church would be an ideal vehicle for administering such a system because it's in a position to encourage healthy lifestyles in areas where the government can't or won't intrude, such as promiscuous sex or excessive drinking.

Other Christian organizations might also play a part. There are many structural discussions to come, but interest in biblical alternatives to governnmental programs in health care, as in welfare, is growing.