THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, August 21, 1994 TAG: 9408200003
SECTION: COMMENTARY PAGE: J5 EDITION: FINAL
SOURCE: PERRY MORGAN
LENGTH: Medium: 67 lines
The worst possible thing has happened to health-care-reform legislation. As its passage - or defeat - has become central to the outcome of midterm elections and to viability of the Clinton presidency, first principles have taken a back seat to partisan posturing. The president continues to dramatize the plight of individual citizens whose misfortune proves nothing about the efficacy of a particular plan of reform. Bob Dole, the Senate minority leader, counsels delay as if time alone is the chief obstacle to effective and affordable reform.
This behavior leaves little room for such questions as: Who will be helped by reform? What will it cost? Who will pay? Is the cost affordable? Is the reform scheme workable? Is Congress the best forum for working out the kinks and complications inherent in any plan?
A congressman no more knows the answers than an ordinary citizen, so the Congressional Budget Office is called upon to spot (but not solve) problems. Regarding the Mitchell proposal, which has supplanted the Clinton plan, the CBO response is guarded. There's doubt that the administrative capacities could be achieved in the time permitted; fear that the practical problems of implementing future mandates in states where voluntary coverage falls short ``could be overwhelming''; concern that insurance subsidies for low-income families might discourage ``people from working more hours or, in some cases, from working at all. . . .'' Wouldn't that outcome conflict with the aims of the Clinton welfare reform?
Many of the CBO reservations, of course, would apply not just to the Mitchell proposal but to any scheme for systemic changes. Such reform all along has been a Herculean challenge involving in scope one-seventh of the U.S. economy and the creation of a vast new entitlement program while existing ones court insolvency. And involving in detail unintended consequences beyond anyone's ability to perceive. Such a program needs design. Congress, even at its best, makes jambalaya: It is so designed.
Once upon a time reform was made to seem so simple. Harris Wofford won a U.S. Senate seat in Pennsylvania by declaring that ``if criminals have the right to a lawyer, working Americans should have a right to a doctor.'' With equal merit, Wofford could have substituted the right of three nourishing meals a day, but let it pass.
Wofford won, and not long afterward a new Democratic president was proposing to expand coverage to 37 million citizens now uninsured and to jack up the benefits of Medicare recipients - all this at a cost of less than doing nothing at all. Bill Clinton may have believed that (the thought is no compliment), but the proposition is no longer with us. What remains is the problem of how to extend coverage without running up unemployment and deficits that put everything at risk.
It can be done, say Democrats: Hawaii has done it. If that is the case, why is the Congressional Budget Office finding so many things to worry about in the Mitchell plan and other schemes? Why, indeed, is the Congress not considering the Hawaii plan? A demonstration project - preferably on the mainland - is just what's needed to get at the realities underlying all the pretty promises.
An incremental approach is safer and surer than immediate comprehensive reform: Little more than the election cycle explains Democratic desire to impose a massive scheme even if passage is so tenuous that a new Congress might try to reverse it. Nothing explains assumption that Congress, thumbing amendments up and down, can draft a plan that runs on all cylinders. MEMO: Mr. Morgan is a former publisher of The Virginian-Pilot and The
Ledger-Star. by CNB