Health Care Reform: Lessons from Missouri

Published November 11, 1994

Contrary to the official “spin” coming out of Jefferson City, Missouri, special interest groups, lobbyists, and big bucks did not cause the legislative defeat of that state’s far-reaching health care reform proposal. The proposal defeated itself, with the help of well informed and loudly expressed public opinion.

During the 1994 legislative session, Rep. Cindy Ostmann (R-St. Peters) told me: “The bill is so badly written that no amount of amending can make it viable.” Rep. Ken Jacobs (D-Columbia) expressed more than one legislator’s feeling when he said in a press interview, “A month is not enough time for me to grasp the consequences of this proposal.”

The scope and language of the Missouri bill were no less overwhelming than the Clinton Administration’s proposed Health Security Act. Indeed, the Missouri Health Assurance Act ran into the same objections that ultimately killed the Clinton plan–too much government, too many employer mandates, too many restrictions on providers, too little choice for consumers, too many price controls, and too little confidence in the projections of the plan’s ultimate cost.

Policy makers and opinion leaders nationwide can learn a great deal from Missouri. The state’s attempt at health care reform typifies the misinformation that pervades the public policy debate in this country. It is a departure from truth and sound analysi s that must be rejected if real reform is to be accomplished–in health care, crime prevention, welfare, or any of a dozen other key public policy arenas.

Author Paul H. Weaver, in his 1994 book News and the Culture of Lying, could have been describing the health care reform debate in Missouri when he wrote:

  • Hard facts and figures are generally accurate–that much is necessary to maintain the credibility of the entire exercise. But the presentation of the facts frequently degenerates into a hodgepodge of artificial crises and falsely heightened plot lines. T he media are less a window on reality than a stage on which officials and journalists perform self-scripted, self-serving fictions.

Even though the impetus for reform allegedly has been that current spending is too high, the Act would have been funded through a revised Medicaid funding scheme and new taxes on employers, health care providers, and cigarettes. The Missouri reform plan w ould have caused a net increase in total health care spending.

Instead of addressing the real causes of high spending in Missouri–government regulations, out-of-control spending on entitlement programs, and public health problems–the Missouri reform plan ignored the real problems and created a monstrous new bureauc racy and set of entitlements. Instead of creating incentives for efficiency and quality, it would have further insulated consumers and providers from real accountability for their choices.

In Missouri, public opinion was strong enough and sufficiently informed to challenge the state’s attempt at health care reform. For the media, the Missouri lesson is about making a commitment to scrutinize what the politicians propose and to present the w hole story, not simply the fabrications that fit a political agenda.

For the public–readers of newspapers and magazines, radio talk show listeners, and television viewers–the Missouri lesson is about cancelling subscriptions, switching channels, and thinking for ourselves. It is about making an effort to gather inform ation, not just entertainment, about issues that are important to us and our families.

Conrad Meier is a public policy analyst for The Heartland Institute. He is a retired health insurance consultant living in Columbia, Missouri, and former state chairman of the health insurance committee of the Missouri Association of Life Underwriters.