AFTER LONG and hard thought about holding down hospital costs, Congress has arrived at a decision: It would rather not. The House Commerce Committee has voted against any sort of enforced limits on the rate at which hospital costs climb. That means no legislation this year. The committee's majority has given in to the hospitals, which argue that no legislation is needed in view of their splendid progress in holding down costs voluntarily. After all, the hospitals point out, their costs were rising at a rate of 16 percent a year in early 1977, when the Carter administration first proposed controls. Currently the rate is down to a mere 13 percent.
But 13 percent is intolerably high, and everybody including the Commerce Committee knows it. The sad fate of this bill is another illustration of this country's uncertain and hesitant attitudes toward controlling inflation. Everybody is against inflation in general. But each specific remedy is open to attack on grounds that it is unfair to someone, or it is too complicated or too harsh.
The Carter administration originally wanted to impose cost controls immediately on the hospitals. But direct controls are a dangerous instrument and need to be considered only as a last resort. A decent and useful compromise was worked out by Rep. Dan Rostenkowski (D-Ill.) in the Ways and Means Committee, giving the hospitals two years to slow down their inflation by their own voluntary means. If they had failed to meet specific targets, under this compromise, the hospitals would only then have come under federal controls. First the administration denounced the idea, then embraced it. Now it has collapsed altogether.
There was a time when rising hospital bills were a public issue of great emotional force. That's evidently no longer true. The explanation, we surmise, lies in the insurance system. Only about 10 percent of the population is not covered by some sort of health insurance. People have to pay heavily for that coverage, but most of them pay indirectly and unconsciously. Much of the cost is paid directly by employers to insurers. Unlike withheld taxes, or Social Security contributions, the health-insurance premiums are not even noted on paychecks.
As we have observed before, the typical family of four with an income of $16,000 a year is now contributing about $2,000 a year to the nation's medical care. The contribution is real, but few families are aware of it. As a political issue, hospital costs do not appear to have much of a public following. The support for the cost-control legislation has come largely from people who have a professional or business interest in the subject: public administrators, economists, some of the insurers. That's not enough to carry a bill as sharply opposed as this one.
The failure of this bill makes the prospect of national health insurance more remote than ever. The arithmetic of the federal budget, now and for some years to come, would make it very difficult to move toward a comprehensive national health plan in any case. But the defeat of this temperate and conciliatory legislation will hardly do much to diminish the fear that better insurance will only mean bigger hospital bills.
It's a paradox: The broader the present patchwork of health-insurance coverage becomes, the less motive Congress has to improve it. The more widely and fairly the financial burdens of illness are spread over the population, the less interest any particular voters show in arresting its further rise. Meanwhile, hospital costs continue to go up, at nearly twice the average rate of all other consumer prices.