President Bush may think he will have secured himself on the health care front for 2004 if he signs a bill providing a Medicare prescription drug benefit to seniors. But he would be wrong. [IMGCAP(1)]

Democrats will criticize the drug plan as inadequate, but basically they’ve moved on to a bigger issue: reforming the U.S. health care system for non-seniors, 80 percent of the population.

Evidence of the power of this issue has come in three forms within the past month — two from Detroit and the other from Boston.

In Detroit, as the Financial Times reported June 9, General Motors is building up inventories against the possibility of a nationwide strike this fall.

The issue with GM’s unions is the company’s demand for more sharing of health care costs with employees — higher premiums, higher deductibles and possible reduction in coverage for retirees.

The second report from Detroit was a late-May speech by William Clay Ford, chairman of the Ford Motor Co., declaring that “health care is just out of control. It’s a system that’s broke. It really scares me enormously.”

Ford thus joins a growing chorus of corporate voices demanding large-scale reform of the health care system, though the solution implicit in his speech — replacement of the employer-based insurance system — would be deeply controversial.

The third piece of evidence of the need for reform comes from a new report in the New England Journal of Medicine showing that, on average, doctors provide their patients with appropriate health care only about half the time.

The Journal reported on the largest and most comprehensive study ever on the quality of health, including examination of the health charts of more than 7,500 adults.

The charts showed that patients received treatments regarded as “medically appropriate” only 55 percent of the time.

They often didn’t get proper cancer screening, blood pressure medicine or drugs to prevent heart attacks.

The study did not try to estimate how many people die each year from medical errors, but it did nothing to invalidate a 2000 estimate by the respected Institute of Medicine that between 40,000 and 90,000 Americans die every year because of preventable medical errors.

The twin issues of cost and quality — along with the swelling ranks of the uninsured — form the makings of a major focus of the 2004 campaign.

Bush evidently hopes that he will be covered on the health front if the Republican-dominated House and Senate can agree on a $400 billion Medicare prescription drug benefit and send him a final measure for signature this year.

But Democratic presidential candidates have raised the bar. They rarely mention the Medicare prescription drug issue at all, concentrating instead on comprehensive health care reform.

Rep. Dick Gephardt (D-Mo.), former Vermont Gov. Howard Dean (D) and Sen. John Kerry (D-Mass.) have made health reform — especially coverage for the uninsured — major items in their campaign platforms.

To the extent that they can make health reform a focus of the 2004 general election campaign, polls indicate that Democrats already hold a huge advantage over Bush.

The Democracy Corps, a Democratic polling consortium, asked voters whether they wanted to follow Bush’s lead on various issues or move in a “significantly different direction.”

On health care, voters wanted to move in a different direction by a margin of 54 percent to 37 percent. On prescription drugs, “significant direction” carried by 44 percent to 39 percent.

Bush will have to pay attention to the broader health care issue for sure if there’s a nationwide auto strike this fall triggered by rising costs and shrinking benefits.

According to the Detroit Free Press, the automakers already are imposing increased cost-sharing on their employees. At Ford, salaried employees with families are being forced to pay the first $600 of their medical bills rather than the $250 they previously paid. GM has increased premiums for retirees by $25 a month.

Nationally, according to the nonpartisan Commonwealth Fund, health premiums are rising at 10 percent to 15 percent per year and health cost represented 14 percent of gross domestic product in 2001, up from 13 percent in 2000.

The fund’s president, Karen Davis, told a Senate Appropriations subcommittee on June 11 that “the U.S has the highest health care spending per capita in the industrialized world, and during the 1990s health spending in the U.S. rose faster than in other industrialized countries.”

At the same time, she said, “Sick adults in the U.S. report higher rates of medical errors, are more likely to go for duplicate tests and are far less likely to have their medical records available when they go for care compared with similar adults in other major English-speaking countries.”

To the extent that Bush has addressed the health quality issue, it’s been to call for legislation to allow doctors and hospital administrators to disclose and discuss errors without fear of lawsuits.

His answer to the problem of rising medical costs is medical litigation reform — caps on malpractice damage awards — to hold down malpractice insurance rates.

Bush has proposed a tax credit to help lower-income Americans purchase health insurance and, in a forthcoming interview with Roll Call, Bush’s Medicare administrator, Tom Scully, said the president might propose measures to reform the insurance market.

But he needs to start thinking about broad-gauge reform to address costs, quality and the uninsured. Those who form his own constituency, America’s corporate CEOs, are demanding it. And his Democratic rivals are promising it.