New baseline of opinion on health care

CULPEPER, Va. — On the day President Clinton went on national television in 1993 to prescribe his remedy for the nation's ailing health care system, emergency room director Michael Bost was too busy treating uninsured patients to believe change would mean improvement.
Sixteen years later, Bost has seen enough physical and financial suffering to convince him that major change is needed. He has watched his sons grow up and become uninsured, bringing their children to emergency rooms and paying hospital bills in installments. He has seen thousands of uninsured patients face the trauma of illness and destitution.
"What I see every day in the ER is magnified 10 times worse than what we experienced back in the '70s," says Bost, 59, now an emergency room physician in Fishersville, Va. "Not only does it hurt them physically, but it hurts them financially."
In Culpeper and across the nation, the years since Clinton's failed effort have seen the cost of medical services nearly double and softened some of the skepticism voiced by Americans in 1993 and 1994. The percentage who say Congress should pass comprehensive legislation, rather than dealing with health care incrementally over several years, has increased by 10 points, USA TODAY/Gallup Polls show.
That could help President Obama and Democrats in Congress as the Senate begins debate next week on an $848 billion plan that would fundamentally revamp the nation's health care system — the first such effort in 15 years. Unlike Clinton's plan, which would have created a new government regulatory system to monitor premiums and benefits, Obama's builds more on the current private insurance system. And unlike Clinton, Obama got most of the affected interest groups — doctors, hospitals, drugmakers, even insurers — to acknowledge that the system needs to be fixed.
To gauge how Americans' views have changed since 1993, USA TODAY spoke to many of the same people from Maine to Washington that the paper's reporters interviewed during Clinton's effort.
Here in Culpeper, a town of 16,000 with a median household income of $44,000 and a history of voting for both Democrats and Republicans, nothing tells the story better than Mort Chiles' path last year from private medical practice to chief medical officer at Culpeper Regional Hospital. He had planned on retiring last July at 60 but decided to keep working — in part to get health insurance through his employer.
On the day of Clinton's September 1993 speech, Chiles doubted Americans would give up any of the expensive care they were used to. Today he's ready to give it a try because the present system, he says, isn't sustainable.
"At some point, there has to be some limit on what we think we can do in health care," he says.
Health care costs, combined with the economic downturn, have caused Don Shuman to cut his small payroll from seven people in 1993 to just three today.
Then, "the economy was rocking and rolling. We were making money hand over fist," says Shuman, who has run Shuman Builders since 1974. His workers had excellent health benefits, he says. As a result, he opposed the Clinton plan, fearing it could lead to higher costs and fewer benefits.
Now, he has been forced to switch carriers and increase deductibles and co-payments, yet he's paying $6,600 a month.
"Change is inevitable, and this is the closest that we've ever come," says Shuman, 66. "If we don't do anything at all, we've missed an opportunity."
'Times have greatly changed'
Personal experiences with the health care system since 1993 have convinced many people that something has to be done.
Lynne Brauser ran a general store in Bradford, Pa., in 1994 and worried that a redesigned health care system would force her to pay her three employees' insurance premiums. "I don't believe Clinton's plan," she said then.
Since then, her husband had a serious illness requiring three months in the hospital, and the couple's insurance paid most of the costs — something she says the uninsured deserve. She also worked as a registered nurse and saw how the uninsured get care today — in the emergency room.
"Times have greatly changed," Brauser, 60, says. "I honestly think that we do need some type of change."
It took a death in the family to convince Judy Grabinski of Rockham, S.D., that insurance coverage should be expanded. The last time Congress considered it, her mother-in-law, Sharon Grabinski, was an uninsured cook in Faulkton, S.D., with diabetes and Raynaud's disease, which reduced circulation to her hands and feet.
In 1994, Sharon Grabinski succumbed to uterine cancer. If the types of low-income subsidies under consideration at the time had been available earlier, Judy Grabinski says, they could have helped pay for regular checkups.
"Some type of reform should be done," Judy Grabinski, 41, says. "Screening should maybe be available for all people."
Barely 12 hours after Clinton unveiled his plan in 1993, Rhonda Yeagerwas treated to a personal sales job by then-Treasury secretary Lloyd Bentsen on the concrete production floor at Philadelphia's Stockwell Rubber. She didn't buy it.
"I think we're all going to get smacked," Yeager said after Bentsen's pitch.
Since then, Yeager's father was diagnosed with Parkinson's disease, and neither Medicare nor his private supplemental policy pays for his full $479 monthly drug bill. Then she was diagnosed with lupus, a chronic autoimmune disease that is causing numbness in her legs, and the costs for medical tests and treatments are mounting.
"We're just going completely broke with the co-payments," says Yeager, 43, who still works at Stockwell, as a finisher.
"At this time, everybody is heading for trouble in terms of medical coverage," she says. "I see it getting worse."
For most of those who date back to Clinton's effort, cost was the big concern then and now.
Maryan Kearney noticed it in 1993 when son John's birth cost the family three times as much as her son Robbie's birth 11 years earlier. She notices it today because her father was billed $8,000 for eight hours in the emergency room with stomach pain, her 27-year-old son struggles to pay his premiums on the individual market, and another son can't afford insurance at all.
"Things have gotten very far out of hand," says Kearney, 53, a dental hygienist in Culpeper. "I don't know how we're ever going to fix it."
It cost David Cousens $546 a month to insure his family in 1993, when his lobsters were bringing in $2.70 a pound. Today, he's paying about $1,200 a month for health insurance. Lobsters? Just $2.50 a pound.
That's the main reason why Cousens, president of the Maine Lobstermen's Association, has shed the hesitation he voiced to Hillary Rodham Clinton during a Boston forum in 1993 and now supports Obama's efforts. It's not the only reason. He wishes he could afford to provide coverage for his one employee. And he regrets that his two children, ages 27 and 23, can't afford it, either.
"I think we need to get it done," says Cousens, 51, of South Thomaston. "Is it going to be perfect? No way. But it's got to be better than what we have now."
'Each one of us is at risk'
In 1993, Eugene Wigglesworthhad five auto repair shops in Vancouver, Wash., and a message for President Clinton. "Call me," he said at the time. "Get back in touch with the people making the jobs."
Sixteen years later, his opposition to changing the health care system has subsided. He and his wife just switched carriers for their Medicare supplemental policy. The old policy was going from $121 to $175 a month and dropping his sole medication.
"I think it's absolutely essential that we get health care reform," says Wigglesworth, 66. "There's just no getting around it now."
Illinois family physician Arvind Goyalread the entire Clinton plan in 1993 and determined that it would "destroy the practice of medicine as we know it." He brought his concerns to the American Medical Association.
Since then, Goyal informally polled his doctors at Northwest Community Hospital in Arlington Heights, Ill., where he chaired the family medicine department. Faced with reduced reimbursements, liability insurance premiums and overhead costs, he found, 30% of them had dropped health insurance for themselves, their families or employees.
"That amazed me," says Goyal, now 61. "These people would be at tremendous risk if they were hospitalized."
With 10% unemployment nationally, Goyal says, "our employer-based system is not protecting us. Each one of us is at risk."
Can government help?
Despite complaints about medical care and rising costs, some of those who opposed Clinton in 1993 see a repeat performance from Obama.
Richard Lee ran his own business, Gayheart's Drugstore, in Culpeper in 1993. Clinton's plan, he said then, would have meant higher insurance costs and more paperwork. Since then, Lee sold the business because insurance reimbursements were late and inadequate. He became the pharmacist at Culpeper's Safeway, a company that has taken costs into its own hands by offering lower premiums to employees who are in good health and offering generic drugs for $4 per month.
"The insurance companies and the drug companies are driving the health care system, and that's not the way it should be," Lee, 55, says. But with reform, he says, "the cost is going to climb."
Dorothy Crone didn't hesitate when she learned Democrats planned to cut Medicare to help pay for their plan. She ran out and got the surgeries she needed.
"I'd advise anybody nearing their 70s, if they have to get any work done, they better get it done while they can," she says.
Crone, a former small businesswoman from Horseshoe Bend, Ark., complained to her congresswoman about the Clinton plan in 1994. Today she's more convinced that government is the problem. "When has anything that the government does saved money?" she says.
Kentucky accountant Kenneth Wolfecomputes the tax burden for small businesses for a living. In 1993, it didn't take him long to predict that Clinton's health care plan would force some of them out of business.
When it comes to Obama's plan, Wolfe, 63, hasn't changed his mind. Still, he's convinced the current system doesn't work. Wolfe pays about $15,000 a year to insure himself, his wife and son, plus co-payments. He wants a high-deductible plan that isn't offered in Kentucky but in Ohio, within "rock-throwing distance" of his Park Hills home.
For Wolfe and many others, the need for cost controls remains paramount. He recalls going to the hospital for a small outpatient procedure and asking what it would cost. "You'd have thought I just landed from Mars," he says. "She said, 'Nobody's ever asked that before.'