Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, August 11, 1994 TAG: 9409090007
SECTION: EDITORIAL PAGE: A17 EDITION: METRO
SOURCE: RAY L. GARLAND
DATELINE: LENGTH: Long
Three reasons can be given.
First, the Clintons did not know how to accomplish what they talked so airily of doing in the '92 campaign. They had no real plan, and when they set their legions of experts to work after taking office, they took months devising a Rube Goldberg contraption that tried to blend a European model of socialized medicine with the system of private insurance already covering a majority of Americans.
After spending millions in secret conclaves of dubious legality coming up with a plan, and lambasting its critics over many months as small-minded churls, was there ever a more shocking admission than the president's recent statement that Sen. George Mitchell's hastily drafted substitute, which abandoned the main provisions of Clintoncare, represented an improvement?
The second reason for the collapse of the president's plan is that it never rested solidly on the will of a sufficient majority of Americans. In the campaign, Clinton presented himself as a new-model, moderate Democrat. Even with that pitch, 57 per cent of the people opposed him. Special Senate elections in Georgia and Texas, both lost by the Democrats, confirmed a climate of opinion hostile to the advance of liberal ideas.
Had the president recognized reality and reached out to Republicans and others outside his core constituency to fashion a bill of attainable objectives, he could have been a hero.
But the most important reason for failure is that the subject is far larger and more complex than the minds that set about encompassing it. Eighty-five percent of the people already had insurance, and polls consistently showed a sizable majority of those satisfied with what they had. Even the oft-stated claim of 37 million uninsured was subject to gross misinterpretation. That figure was drawn from census data, which was simply a snapshot in time. More sophisticated analysis showed that a majority of those uninsured at a given moment reacquired coverage within 12 months.
The Clintons could have attacked the problem of the hard-core uninsured, which are mainly those with special health problems or those working for marginal businesses at low wages, by allowing them to enroll in Medicaid at rates tailored to their incomes. But they were hoist on their own petard of wanting to make the whole thing seem as cost-free to the people as possible.
That was the reason for relying upon a complex funding mechanism, blending a tax as high as $20 a carton on cigarettes with top-heavy employer mandates, further cuts in Medicare and taxes on various aspects of the health system itself. Even so, the component remaining to be funded by the treasury was estimated as high as $90 billion a year by 1997. In truth, nobody ever gave a reliable estimate of costs.
Logically, a national health plan would have covered everybody with the same benefits package, paid for on the same basis as Social Security, which is 50-50 between employers and employees. But most workers now receiving health insurance from their employers pay far less than that. Even for the uninsured, a 50-50 cost-sharing plan would have seemed a letdown.
Given these factors, the Clintons faced severe constraints. They could not be seen opposing the labor unions by taking away anything the unions had won at the bargaining table before health costs were such a big deal. As liberals, they could not be seen asking workers to share equally with employers in paying for health insurance. As caring people, they could not be seen offering only bare-bones coverage to the uninsured or the underinsured.
In trying to reconcile the irreconcilable against a backdrop of an existing $4.6-trillion debt, growing at more than $200 billion a year, they could never convince even a sizable majority of congressional Democrats that they had the answer.
But the exercise has not been without benefit. By thoroughly scaring the medical establishment, the Clintons have certainly contributed to a more significant slowing of the growth in health costs than George Bush would have done.
There is this warning: Cost-containment efforts initiated by large corporations and the government itself through Medicare and Medicaid will shift more of the burden onto small business and private citizens purchasing their own care with their own money. This problem will have to be addressed before long.
The Clinton effort has produced another, quite unintended benefit. By its sheer incompetence and hubris, it has probably inoculated most Americans for some time to come against demagogues claiming to know a quick and relatively painless fix for the ills of one-seventh of the total economy.
Mrs. Clinton may be right in saying that if her plan fails, the next step will be a single-payer plan run by the government along the lines of the Canadian system. There can be little doubt that such plans cost less. The United States now spends close to 15 percent of its national income on health compared to about 9 percent in Canada, and as little as 6 percent in Great Britain. But there are tradeoffs, such as less investment in new facilities and technology, and outright rationing of care.
If Republicans gain enough seats this November to enjoy effective control of one or both houses of Congress, they should not repeat Bush's mistake of dropping the subject, proving once again they are more effective in opposition than in charge. Recognizing that comprehensive change along either conservative or liberal lines is politically impossible, they should address such parts of the problem as they can.
Ray L. Garland is a Roanoke Times & World-News columnist.
by CNB