ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, May 26, 1996 TAG: 9605240002
SECTION: HORIZON PAGE: 1 EDITION: METRO
SERIES: the system
SOURCE: HAYNES JOHNSON AND DAVID S. BRODER
President Clinton was right in 1993 and 1994 in saying that runaway health costs were robbing America of its future. Republicans foiled his solution. Now, it appeared he was going to try to foil theirs. It was exactly the kind of behavior that was destroying public faith in The System.
By 1996, a year after the Clinton effort crashed, the triumphant Republican majorities in Congress struggled with the same runaway costs of the largest federal health programs, Medicare and Medicaid, that led Clinton to try to reform them. The increasingly fractious battle between the Democratic president and the Republican Congress over the federal budget that resulted in the longest shutdown of the federal government in history exposes the greater struggle that health care symbolizes: over two conflicting visions of the role of American government and the values of the society at century's end.
Two conflicting visions of the role of government
and the values of the society at century's end.
On Aug. 18, 1994, with the prospects for health care reform fading with each passing day, Democrats gathered for their weekly leadership luncheon.
Sen. Bob Kerrey was blunt. Eighty percent of the people in his state of Nebraska wanted them to do nothing, he said. They were frightened by what they heard about the Clinton plan. He told them why he thought the majority leader's strategy of seeking to pass health reform by the minimum 51 votes, far short of the 60 needed to defeat a filibuster, was misguided. He also said that a compromise health care reform bill offered by Majority Leader George Mitchell, D-Maine, was seriously flawed. If they kept on this way, Kerrey said forcefully, they were going lose the Senate. He repeated himself, even more strongly: They were going to lose the Senate! He finished what he had to say, got up, and walked toward the door.
Sen. Ted Kennedy, D-Mass., was seated farther down the table and clearly didn't like what he had heard. His face got red. Isn't somebody else going to get a chance to speak? he said, in a booming voice. Then he launched into a full-scale attack on the views expressed by Kerrey. Kennedy, his voice rising ``in full roar''- as a fascinated Lawrence O'Donnell, Sen. Daniel Patrick Moynihan's Finance Committee chief of staff described it minutes later - derided what Kerrey had said, and became more and more emotional. It was, O'Donnell characterized it, ``a wall-shaking, unprecedented'' moment.
Suddenly, Kerrey, who was just about through the door, wheeled around and stalked back into the room while Kennedy was still speaking. He stormed back to a point directly across the table from Kennedy, and confronted him in a tough, loud voice. The Mainstream group of moderate Republicans and Democrats doesn't have to meet, he shouted. It can stop right now. We can vote right now on Mitchell, and It will go down! Again, he repeated himself: It will go down! Kennedy, stung, roared back. God, O'Donnell thought, it's like two Irish pugs, two Boston Southies, of differing generations and backgrounds, brawling on the street corner.
Dead silence. Finally, after what seemed like an interminable moment of tension, the soft drawl of Wendell Ford of Kentucky broke the silence. ``Well, George,'' Ford said addressing Mitchell, a smile creasing his face, ``that's about the best exchange I've heard.''
Another explosion of emotion, this time the laughter of relief which Ted Kennedy joined in.
John Glenn of Ohio, usually laid-back, phlegmatic, mild in manner and speech, thought he had the answer: ``Charge!'' Glenn, the first American to orbit the Earth and a valorous Marine combat fighter pilot in World War II and Korea, took Bob Kerrey on. He didn't agree with Kerrey, he said. I'd rather lose the Senate fighting for something we know is right, Glenn continued, to an outbreak of applause from his colleagues. If we're not going to be victorious, I'd rather go down with flags flying. Jesus, O'Donnell thought, the only two guys in this room who can really talk about flags flying are on opposite sides. Kerrey, representing the other divide of the combat generations, and the new rifts in the Democratic Party, listened stonily; then, as more applause sounded, he turned and walked out of the room.
In November, voters delivered the worst midterm repudiation of a president since Harry Truman in 1946 and signalled the most decisive shift in the role and direction of government since Franklin Roosevelt and the New Deal. They broke the 40-year hold of the Democrats on Congress, restored Republicans to power at every level of government, and set the stage for a further test over the nation's ideological future in 1996, the last presidential election of the century.
In the campaign Republicans offered a ``Contract with America,'' a list of things they would do if given a majority. Reforming health care was not part of the Contract; nonetheless, it was a key part of the Republican campaign strategy. Across the country, Republican candidates denounced the Clinton plan in their campaign ads and speeches; they depicted it as the pre-eminent symbol of the ``Big Government'' they opposed. In Republican rhetoric, the Clinton plan was ``the mother of all entitlements,'' something that would force higher taxes and produce even greater deficits. It was ``bureaucracy run amok.'' It was a threat to the American way of life.
Repeatedly raising the specter of a ``government-run health plan'' accomplished many things for Republicans, Gingrich said, in a rare burst of understatement. First, it ``scared everybody. If you were a senior, you got scared. If you were a doctor, you got scared. Suddenly, everybody is driven to us and you have this huge, grand coalition forming. Combined with the tax increase of '93, gays in the military, [it gave voters the sense] that these folks were committed to a government-controlled, left-wing vision of America.''
From the beginning, these were the themes that Gingrich and his troops had brilliantly employed to bring about their ``Republican Revolution.'' Playing on mistrust and fears of government enabled Gingrich to use the health battle as a powerful symbol of the failings of the liberal, welfare state. Even a full year before Bill Clinton was nominated for president, Gingrich had plotted to defeat any Democratic attempt to provide universal health care for Americans. Only by defeating what Gingrich was convinced would be this next great domestic policy of the Democrats could he fulfill the goals of the Revolution: win back control of Congress, with himself as its dominant figure.
House Republicans made their 100-day deadline for voting on the Contract with a week to spare. They won approval for every one of their promises except a term-limits constitutional amendment. During those initial months of the new Congress, while the spotlight blazed unceasingly on the Contract, the issue that had brought Clinton and the Democrats so low and elevated Gingrich and the Republicans to such intoxicating heights merely flickered backstage.
But as soon as the Republicans in April 1995 turned to writing a budget, health reform proved to be as powerful and vexatious an issue as ever. This time, however, the shoe was on the other foot. Now Republicans discovered they could not achieve their objectives without addressing the very same questions over which the Clinton administration had fought and nearly died for two years. They even adopted some of the same arguments, arguing that managed care and health-maintenance organizations would make the system more efficient and less costly.
That deeply ironic situation appeared to be all right with Bill Clinton. As the shock of the election defeat sank in on the president, he complained to advisers about the fickleness of the public. Republicans had spent two years saying no, he said, and here they were, rewarded with virtually every prize the voters could give them. The president thought he had taken on the hard issues; in return, he got nothing but abuse.
The budget the president sent to Congress proposed no savings for Medicare. It contained no new health care proposals. Clinton was walking away from the problem, Republicans now complained. What he was really doing was forcing them to take the first step - and now it was their shoe that pinched. Republicans resented being placed in that position, even though they had profited when Democrats failed at their reforms the year before.
The first sign of trouble for the Republicans came on Feb. 14, 1995, when Senate Majority Leader Bob Dole announced that in order to meet the Republican goal of balancing the budget within seven years ``savings'' of $146 billion in Medicare spending and another $75 billion in Medicaid would have to be achieved. At that point no significant health care legislation was moving through the new Republican-controlled Congress.
When Senate and House Republican budget chairmen Pete Domenici of New Mexico and John Kasich of Ohio unveiled their plans, they asserted that they could balance the budget by 2002 without a tax increase. Indeed, the initial Kasich House budget version called for a huge tax cut for families with children and for investors eager to cash in their capital gains.
Balancing the budget within seven years without a tax increase, even substantially reducing taxes, all while calling for additional federal spending on defense, was a political wizard's trick rivaling the sleight-of-hand maneuvers during the early Reagan years of supply-side economics. To reach that goal, both Republican budget chairmen asked for unprecedented reductions in the two largest federal health care programs, Medicare and Medicaid. They proposed taking more than $250 billion from Medicare, reducing its annual growth rate by a third, and more than $175 billion from Medicaid, with even sharper curbs on its projected growth.
Once again, the battle lines had formed. Less than a year after the Republicans had boasted to each other of having killed health care reform, and after their victory had helped produce the greatest electoral turnover in decades, they found themselves facing the same intractable problems that the Democrats had tried, and failed, to address. Only this time, the pressure was on the Republicans to persuade a doubtful public that their plan would save and strengthen, not weaken and destroy, the health care system.
The Republicans recognized the danger. They tried to ward it off by demanding that Clinton act responsibly with them to save the health system. Join us in creating a bipartisan commission to suggest needed changes in Medicare, Gingrich and Dole publicly urged the president. The White House declined and Chief of Staff Leon Panetta responded to the Republican leaders in writing. No matter how you disguise it, ``no one can hide the reality that you are essentially calling for the largest Medicare cut in history to pay for tax cuts for the well-off.''
It was a powerful political argument, and the Republicans knew it. Now the Democrats were on the offensive.
Though they continued to claim their overall budget reduction of nearly half a trillion dollars was not a cut, but only a reduction in the rate of growth of the programs, the Republicans offered no specifics on how these changes would be achieved - at what cost and to whom. Meantime, they were also proposing a tax cut of $245 billion. It didn't require a mathematician to make the connection between a Medicare cut of $270 billion - up from the previous figure - and a tax cut of $245 billion. The Republicans had handed the Democrats a powerful weapon, and Democrats swiftly employed it. The true purpose of the massive health care cuts, they argued, was to permit Republicans to give a tax cut to the wealthiest Americans.
What the Democrats chose to ignore, for the moment, was something that Clinton and all the rest of them knew to be the case: the growth in Medicare spending was unsustainable. In 1970, five years after it began, it accounted for only 3 percent of the budget. In 1994, it was 11 percent. By 2005, the Congressional Budget Office said, it would reach 17 percent. After that, it would get much worse, because from 2010 on through 2025 the baby-boomer retirement wave would vastly expand the number of seniors claiming medical benefits.
President Clinton was right in 1993 and 1994 in saying that runaway health costs were robbing America of its future. Republicans foiled his solution. Now, it appeared he was going to try to foil theirs. It was exactly the kind of behavior that was destroying public faith in The System.
A year after the battle over the Clinton plan had ended, at a time when it was not clear whether Gingrich's Medicare and Medicaid changes would become law, we talked again with Bill Gradison, the head of the Health Insurance Association of America. Like Gingrich, he observed that ``from a private sector point of view, one could argue that the inability of the government to bring about significant change gives the private market a chance to develop without major hurdles. On the other hand, there are actions which only the government can take which are really needed.''
Gradison added: ``I told my members when Congress went home in 1994 that there were no winners and a lot of losers in the great health care debate. The problems were still there. The number of uninsured was already at unacceptable levels and was going to rise. The level of health care inflation, while moderating, was still too high. These things require action. That is still my view.''
It is our view, as well, that in this great test, The System failed the people it was designed to serve. The goal of providing affordable quality health care for all - more substantially addressed, if not fully achieved, by every other advanced industrial country in the world - is further from realization in the United States in 1996 than it was at the beginning of the decade. When the debate began, a broad public bipartisan consensus had developed on the need for fundamental reform, although not on the best policy to pursue or on the solutions people were ready to support. The battle was fought amid the most favorable conditions in this century.
How great a failure this turned out to be became clear over the next year. Many of the problems that prompted the Clinton initiative remain, and one of them, the number of uninsured Americans, grows steadily larger. Medical inflation continues. Public health services for the poorest Americans rapidly erode, and older Americans in need of health care are finding themselves threatened with higher costs for reduced services. States, counties and cities, which face sharply reduced federal support, search in vain for local tax dollars to maintain basic services. Major public hospitals close. The already great chasm separating America's haves from its have-nots continues to widen. By 1996, a year after the Clinton effort crashed, the triumphant Republican majorities in Congress struggled with the same runaway costs of the largest federal health programs, Medicare and Medicaid, that led Clinton to try to reform them. The increasingly fractious battle between the Democratic president and the Republican Congress over the federal budget that resulted in the longest shutdown of the federal government in history exposes the greater struggle that health care symbolizes: over two conflicting visions of the role of American government and the values of the society at century's end.
The failure of The System on health reform might not loom so large if other great challenges facing the society were being met. They are not. Personal safety, economic opportunity, international peace, and health care are the four great security questions by which the American people judge the quality of their lives. On all but one of these, international peace, the last quarter of the 20th century has witnessed the failure of The System to meet the legitimate expectations of the people it is supposed to be serving. | ``The System: The American Way of Politics at the Breaking Point'' b Haynes Johnson and David S. Broder. 1996 by Haynes Johnson and David S. Broder. Reprinted by permission of Little, Brown and Company Inc.
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