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

DATE: WEDNESDAY, August 31, 1994                   TAG: 9410120020
SECTION: EDITORIAL                    PAGE: A10   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

HEALTH-CARE REFORM: A MATTER OF CLASS?

AMERICANS like to think theirs is a classless society. At worst, they like to think, poverty exists in an essentially middle-class society only as an anomaly - a temporary phenomenon (for example, among newly arrived immigrants), or a correctible one (as in the case of the undereducated, the lazy, or others whose plight is regarded as the result of their own behavior).

Like most widely held paradigms, this one isn't without some truth. For many immigrants and their descendants, America has offered remarkable social and economic mobility. Higher skills do bring higher pay. Though sometimes honored more in the breach than in the act, the ideology of equality of opportunity has remained central to our nation's reason for being.

But the paradigm is fraying, and the fate of health-care reform is one example of the loosening threads. The high hopes of just a few months ago, when universal coverage seemed a real possibility, have fallen dramatically.

For that, blame in part President and Hillary Clinton's political mismanagement. They turned an already complicated issue into a proposal so unintelligibly complex and mistakenly micromanaged that it was destined for discard. In addition, such cost-control measures as reform of medical-malpractice law somehow fell by the wayside.

Those, however, are reparable shortcomings. The deeper difficulty has to do with the subject Americans don't like to talk about: socioeconomic class.

At first, a broad coalition favored deep reform. The primary beneficiaries of universal coverage would be the roughly 40 million uninsured, mostly workers in low-pay, low-benefit jobs, and their families. Also behind reform was big business, worried about rising health-care costs and aware that it was subsidizing smaller employers without employee benefits. Fearful of loss of insurance with job changes or major illness, much of middle-class America also backed reform.

A recovering economy and a slowdown in the escalation of health-care costs broke up the coalition. The U.S. Chamber of Commerce has backed off. According to one poll, 42 percent of Americans today fear losing their health benefits, compared with 53 percent a year ago.

All this is ironic in more ways than one. Clinton policies have contributed to the otherwise positive developments of economic rebound (via deficit reduction) and health-cost control (via the intensity of administration interest in health-care reform). And much of the cost-escalation slowdown is due to the private sector's implementation of "managed-competition" concepts which were fiercely attacked in the administration's proposal.

Reforms that appeal to the middle class - insurance portability, a requirement that insurers liberalize provisions regarding pre-existing conditions - may well get through Congress. Much less likely, however, is any serious effort for the universal coverage that would most benefit the working poor. They'll still get care, but too often too late, and often at the cost of becoming charity cases.

While Franklin Roosevelt had middle-class Americans appreciating their solidarity with the working poor, Ronald Reagan helped convince the middle classes to resent poor people. Today, America is still unwilling to commit to the proposition that if you work, you shouldn't be impoverished, still unwilling to make reality conform more fully with its self-image.

by CNB