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Symptom of the Problem

Rendell's health-care proposal not quite a cure-all

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Let's say you go to the doctor with a splitting headache. He does a complete work-up and, after the results come back, tells you you've got an aneurysm.

"Can you do anything about it?" you ask.

"Weeeeellll, it's tricky to get at," he says. "There's really nothing that can be done. But on the bright side, I also found out you have high cholesterol, rickets and an enlarged prostate. And those are things we can do something about."

Clearly, you're better off than you were before. But you haven't exactly been cured, have you?

That's my prognosis for Gov. Ed Rendell's plan to reform Pennsylvania health care.

That plan could fix a lot of what's wrong with health care, because it goes beyond merely helping working-class people pay for insurance. To address the costly health effects of childhood obesity, for example, Rendell proposes expanding school-breakfast programs and wellness education. And he seeks to address racial disparities in health care, right down to requiring "real-time language-translation services in hospitals."

These may sound like little things, but a dime of prevention can be worth a dollar of cure. Rendell claims, for example, that the state could save $3.5 billion a year just by avoiding infections contracted in hospitals.

You'd almost call this course of therapy holistic ... except there's a big hole right in the middle of it.

For all the wonders of Rendell's insurance plan, it does very little about the insurers themselves. Administrative costs at private insurers -- including executive salaries and marketing campaigns -- account for an estimated 30 cents of every dollar spent on health care. By comparison, government-run programs like Medicare spend closer to 3 cents per dollar on overhead.

But while Rendell's plan frets over the fat kids in the classroom, it leaves fat cats in the boardroom largely untouched.

To be fair, the administration does promise to "strengthen oversight of health-insurance companies and HMOs," by requiring at least 85 percent of premiums from small-businesses to be spent on health care. The Rendell plan also limits the premiums insurers can charge to employees at small business.

But if all these interventions are necessary, why not just cut out the middleman, and get rid of the insurers altogether? Why not propose a government-run single-payer system, of the kind that just about every industrial society in the world already has?

The Rendell administration says that 92 percent of Pennsylvanians have insurance already, and that it makes more sense to build on that success. While acknowledging that there are "significant merits to a single-payer model," the administration argues, the goal "of insuring all Pennsylvanians can be achieved without collapsing the private insurance market."

Maybe. But I suspect there's another reason. Special-interest money is the lifeblood of politics ... and few politicians want to undergo an operation in which they might bleed out.

When Rendell recently hosted a $2 million bash to inaugurate his second term, the affair was partially paid for by health-care providers. According to published reports, Highmark and a subsidiary shelled out $50,000. Capital Blue Cross shelled out the same amount, as did health-care giant UPMC.

That influence probably wouldn't diminish even if we got a leadership transplant in the governor's mansion. To take just one example, a PAC affiliated with Highmark contributed $6,000 to Rendell's gubernatorial campaign last year ... but it made more than 270 contributions to other state politicians as well. Recipients sat on both sides of the aisle: House Republican strongman John Perzel raked in $8,400 from Highmark, while Democratic kingpin Bill DeWeese took $3,925.

And I don't see much hope for a transfusion of political courage. The sheer scope of Rendell's plan means it offers plenty to attack. Conservatives are already saying the plan represents a step toward "socialized medicine" -- even as lefties grouse that it isn't nearly socialized enough.

So the insurance executives, who've benefited most from the status quo, won't be too threatened by Rendell's reforms. How could they be, when Rendell's principal goal is to ensure that more people buy their product?

Just thinking about it gives me a headache. I wish Harrisburg had more specialists capable of coming up with a cure.

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