THE SLEEPING-PILL EFFECT is bound to develop in any public-policy issue that inconclusively endures for decade after decade -- regardless of what's at stake in that issue. If your doubt it, consider national health insurance.
In terms of ist potential impact on the well-being of the citizens of this country, it is perhaps the most important domestic item on the legislative agenda. We have the impression, however, that as far as most people are concerned, national health insurance is a big yawn. By virtue of its complexity, immobility and ever presence it has become, for many, a 30-year bore.
We hope this imbalance between public interest and public importance will generate some interest -- in both political and journalistic circles -- in the need for rejuvenating the subject of health-care policy and treating it in less specialized terms. We don't doubt, for example, the importance of careful calibration of medicine's slice of the gross national product, or the various other computational mattes that are zestfully tossed about by health-policy experts. But, with still another debate over national health insurance now shaping up, we'd like to see the participants give direct attention to the down-earth matters that people worry about in connection with health and medical care.
For instance: What effects would the various schemes have on access to medical care -- among those who are now poorly served, as well as among those who are pleased with what they have?
Giving the poor added purchasing power for medical care is no great trick. The so-far unresolved problem is getting physicians and other health-care personnel to work in the inner cities and underserved rural areas. Wishing, hoping and exhorting can't do that. Would national health insurance provide a means, or would the same maldistribution persist?
Since the great majority of Americans do not consider themselves to be in an adversary relationship with the health-care system -- poll after poll finds great satisfaction with the quality and availability of medical care -- it's worth asking what effect national health insurance would have on this substantial number of citizens. If a purposeless disaffection is to be the outcome of a new system, why bother? On the other hand, if the present strengths of medical care will be maintained or expanded, then it will be easier to muster popular support.
It would also be desirable to spell out in some detail what you pay and what you get. And in regard to the increasingly confused issue of cost controls, it would be similarly desirable to make clear to the citizenry that costs are controlled through a process of elimination; it can be waste that's eliminated, or it can be services or conveniences. If, as Mr. Carter insists, national health insurance must be linked to effective restraints on rising medical costs, if would be reassuring to see the "hit" list.
Then, too, we think it would be useful to have some understanding of the paperwork implications for patients and those who care for them. Will national health insurance spawn a great bureaucratic nightmare, or is it possible to keep its administration plain and simple?
There are many other aspects of national health insurance that we'd like to see clarified. But for the purpose of awakening a general interest in this drowse-in-ducing subject, we offer the above items as starters.