What happened to the extravagant hopes of last fall, when the country seemed ready for massive health reform, and Clinton seemed secure at the helm? Today voters are baffled by the politicking and jargon, by all the jockeying over ““mandates’’ and ““triggers.’’ Although 74 percent of respondents in a Newsweek Poll last week said they approve of the idea of universal coverage, increasing numbers doubt that the Clinton plan is the way to achieve it. (Only 33 percent said they thought the plan would be good for the country.) Many middle-class taxpayers have come to regard Clinton’s proposal as a Rube Goldberg contraption – an overly complicated, bureaucratic throwback to Big Government – put together by tax-and-spend liberals to help the poor at the expense of everyone else.
Clinton’s failures on health care have been many, but the most damaging was his inability to explain why universal health coverage matters to the middle class. Clinton threatened during his State of the Union address last January to veto any bill that falls short of delivering universal care. But his standard rationale – that it’s necessary for the 37 million Americans who now lack health insurance – does not satisfy the many more millions of taxpayers who already have health coverage. They fear they’ll wind up getting less care and paying more under the Clinton plan.
It’s not that voters want to preserve the status quo. Most Americans believe that the current health-care system needs to be reformed. They fear that if they lose their jobs, they will lose health insurance; that if they are already sick, or have a sick family member, they won’t be able to get insurance, and that in any case, they won’t be able to afford it.
These are the worries that lawmakers, Democrat and Republican alike, would like to address. The most obvi-ous target is the health-insurance industry. Shortly after Clinton’s election, First Lady Hillary Clinton made the insurance business the enemy for cherry-picking the healthiest customers while denying coverage to the old and sick. One obvious step, basic to most health-reform plans, is to require insurance companies to take all comers. But if insurance companies have to pay the cost of caring for the sick as well as the healthy, premiums will inevitably go up. How, then, to guarantee health care – and at the same time keep down the costs to consumers?
The only solution is to spread the expense. Everyone has to participate, even young, healthy people. If the insurance companies can make a big profit on the healthy, they can then afford to pay for the sick.
This is the most basic rationale for universal coverage. There are only two ways to achieve it, short of the government taking over health care. One is to require employers to provide health insurance. This was the path chosen by President Clinton’s health-reform plan, which ““mandates’’ businesses to cover their workers. The other is to require individuals to buy health insurance, just the way they must buy auto insurance in most states. Republicans, who dislike employer mandates because they place a heavy burden on small businesses, tend to prefer the latter approach.
As recently as a few months ago, a clear majority of members in both the House and Senate had signed on to bills that made universal coverage their goal. Then politics intervened. The small-business lobby, one of the strongest on Capitol Hill, launched a furious attack on employer mandates. At the same time, Republicans began to have qualms about individual mandates. Sen. John Chafee of Rhode Island, the chief sponsor of the Republican bill, was often asked by nervous colleagues how he would respond to a campaign ad that declared: ““Democrats want your boss to pay for health insurance. Republicans want you to pay.’’ Chafee had no bumper sticker in reply.
The insurance industry struck back at the Clinton plan with a vengeance. A clever $10 million campaign of ““Harry and Louise’’ ads mocked it as Big Government run amok. It soon became clear that there weren’t enough votes on the Senate Finance Committee to pass health-reform legislation that included any ““mandates’’ – either on employers or on individuals – to pick up the cost of health care.
In their usual way, the senators began looking for a way to slide out of this predicament. They conveniently seized on a report by a consulting firm called Lewin-VHI, which declared that Congress could achieve meaningful health reform without requiring either individuals or business to pay for it. The study showed that insurance reforms designed to stimulate competition in the marketplace could extend coverage to 91 percent of all Americans, up from about 85 percent now. The study, Chafee says with a sheepish smile, was ““a nice life raft.’’ There are a few holes in it, however. To get to 91 percent would increase the deficit by $115 billion over three years. And 25 million Americans – most of them middle class – would still be left uncovered.
Some reformers, particularly in the House, are pushing the idea of ““triggers,’’ which would give voluntary reforms a chance to work but require that government controls kick in automatically if the goal of universal coverage hasn’t been reached by a certain date. But even this gimmick is a long shot. Clinton’s plan seemed in a free fall last week; Republicans sensed an opportunity to humiliate Clinton by killing off health reform altogether. House Republican leader Newt Gingrich instructed GOP members to forget trying to improve health reform. ““We should not get between the president and the voters when support for his health-care plan is collapsing,’’ he said.
Clinton can only hope to shift the blame by accusing the Republicans of obstructionism. In desperation, he has turned to Hollywood. Clinton allies have been talking to Hollywood mogul Michael Ovitz about getting producer Steven Spielberg to produce TV commercials on health care. Spielberg has some practice at bringing dinosaurs to life, but not even a master of illusion could revive Clinton’s grandiose plan for health reform.
