Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SUNDAY, September 19, 1993                   TAG: 9309190098
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-1   EDITION: METRO 
SOURCE: Knight-Ridder Newspapers
DATELINE: WASHINGTON                                LENGTH: Medium

PUSH FOR HEALTH REFORM CAME FROM THE PEOPLE

They all failed - beaten by big business, the medical establishment and widespread public contentment with the status quo.

Now, President Clinton is embarking on an even bigger undertaking. On Wednesday, he will unveil his plan to guarantee universal health insurance and control runaway health care costs.

It would be the most sweeping expansion of federal social-welfare power since Lyndon B. Johnson's Great Society in the 1960s.

History strongly suggests that any president as politically weak as Clinton is doomed to fail at such an outsized ambition. But a remarkable confluence of economic and political forces today persuades many analysts that Clinton stands an excellent chance to triumph.

Why now?

Everyone - Big Business, Big Labor, the medical establishment, leaders of both political parties and most important, Jane Q. Citizen - recognizes that the U.S. health care system is broken.

It costs too much. It is rife with waste. It fails to provide secure medical coverage to tens of millions of Americans. And virtually everyone wants it fixed.

As usual, the people were ahead of the politicians.

"Something dramatic happened in the 1980s," said Lawrence R. Jacobs, a political scientist at the University of Minnesota, referring to a landslide shift in public opinion. Together with a colleague - Robert Shapiro of Columbia University - Jacobs studied more than 1,000 opinion polls on health care conducted since 1970.

Suddenly between 1987 and 1991, the polls showed, the proportion of people saying they wanted the health care system "completely rebuilt" more than doubled.

At the same time, the polls also showed "a dramatic rise in personal anxiety" about health care costs and an equally sharp rise in public empathy for the plight of people without health insurance, Jacobs said.

Some 37 million Americans have no health insurance. One million people lose coverage every year now. And one in five privately insured Americans - 30 million - will lose coverage at least once during the next 32 months but only two-thirds of them will get it back, according to the George Washington University Center for Health Policy Research.

Forces of economic change are driving these trends and the shifting public attitudes accompanying them.

Beginning with the recession of 1981-82 - the worst since the Great Depression - corporate America began cutting back health benefits for employees and making them pay more for them.

Business executives had little choice; their health care costs were soaring out of control. Health care spending accounted for 7 percent of the U.S. gross domestic product in 1970, 14 percent today and is projected to hit 18 percent by year 2000.

In response, business executives cut costs. They made employees pay larger shares of health insurance premiums. They cut benefits. Many stopped offering health insurance altogether; those that kept it paid for it by limiting pay raises.

The trend is accelerating. This year 90 percent of business executives plan to raise employee health insurance premiums as medical costs rise, according to a July national survey by Business & Health magazine. And 40 percent said they also would cut benefits, up from 16 percent in 1992.

The soaring health-cost trend is also wrecking state and federal government budgets. Medicare costs rose 10 percent a year, on average, from 1967 to 1991, as Medicaid costs rose 16 percent annually.

The people pay all the bills in the end, of course.

"In practice taxpayers foot the bill for government programs and households pay indirectly for employers' shares, either through lower wages . . . higher prices of goods and services, and/or lower profits," Moon of the Urban Institute told Congress' Joint Economic Committee. "One way or another, these large total health care costs - $4,050 per capita in 1993 - are borne by American households."

Politicians finally realized how upset people were about this in 1991, when little-known Harris Wofford ran for the U.S. Senate in Pennsylvania on a guarantee of national health insurance. He upset favorite Dick Thornburgh, a two-time former governor and U.S. attorney general.

"Once you had a watershed event like that, then lots of people started to get involved," said Jim Bentley, senior vice president of the American Hospital Association.