On health care, Democrats again fumble the ball

Robert Kuttner

June 11, 1991|By Robert Kuttner

THE Democratic leadership in Congress -- if you will excuse that contradictory phrase -- is unveiling its grand design for fixing the health system. The proposal speaks volumes, not just about what ails America's system of medical care, but about what ails the Democrats.

The plan, to be sponsored by Sens. George Mitchell, Jay Rockefeller, Edward Kennedy, among others, as well as Reps. Richard Gephardt and Henry Waxman, looks universal health insurance in the eye -- and flinches.

Instead of embracing a Canadian-style, comprehensive system, the Democrats would complicate the existing patchwork of separate Medicare, Medicaid and private insurance programs. Touchingly, they propose to expand Medicaid into a system for the working poor -- forgetting that Medicaid began as just such a program in 1965, before it fell victim to the inflationary logic of fragmentation and to budget cuts. They duck the issue of long-term nursing care altogether.

The universal coverage in the Democratic plan comes from mandating large businesses to provide private insurance, taxing small businesses to finance coverage for employees without insurance and extending federally funded insurance to other uninsured people such as the unemployed. In short, the plan would add another cumbersome layer to a tottering cake.

The political center of the country has drifted so far to the right in the last quarter of this century that the Democratic plan is roughly that which Republicans were proposing back in the Nixon era. Should such a bill pass Congress, President Bush in all likelihood will veto it anyway as too expensive and too socialistic, and the exercise will have been for naught.

The Democrats have been in a prolonged ideological coma ever since Ronald Reagan took charge, with his insistence that the only thing wrong with America was its government. The past decade has provided a pretty good test of that hypothesis. The legacy of privatization and deregulation includes everything from rotting public facilities, busted savings and loans, radical swings in air fares and (of course) a health system that charges more and delivers less than any in the world.

In the health issue, history has handed the Democrats an emblematic conservative policy failure that could deliver them from the political wilderness.

The health care crisis demonstrates, contrary to conservative ideology, why certain social questions simply cannot be left to free markets. In this case, we can't trust markets to dictate who shall live and who shall die.

The crisis demonstrates why the promise of deregulation is a fantasy. Once government gets into the business of mandating or helping to underwrite health care, government had better make sure that care is delivered effectively.

And it demonstrates why a universal public system can produce more choice, more reliability and more efficiency than a patchwork of private systems. That is the verdict of a plethora of studies comparing the U.S. system with the universal systems of other wealthy nations.

The health care crisis could enable liberals to teach the public, to rebut conservatives, to reclaim their own first principles and to identify with well-placed public worries.

However, so insecure are the Democrats, so distanced from their own principles, that they won't embrace this gift. For the most part, after being hammered for a decade, they have bought conservative claims about the inevitable superiority of markets and the inevitable incompetence of government.

The few exceptions to this -- such as populist Sens. Bob Kerrey of Nebraska or Paul Wellstone of Minnesota, or Socialist Rep. Bernie Sanders of Vermont -- do support a universal health system. These legislators, dismissed as hopelessly utopian, are where the mainstream of the Democratic Party was on this issue two decades ago.

Reaganism did a lot of damage to American liberalism while President Reagan was in power. His influence lives on, in the continuing paralysis of the Democratic Party. If the Democrats can't regain their health on the issue of health care, they are beyond treatment.

Robert Kuttner writes a column on economic issues.

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