Health-care wars now go public

Arthur Caplan

May 28, 1993|By Arthur Caplan

I AM now a veteran of the health-care wars.

Two weeks ago I was formally mustered out of Hillary Clinton's health care legion.

Since March, I have been making weekly trips from the University of Minnesota to the nation's capital as one of the more than 400-person army that constituted the Clinton Domestic Health Policy Task Force. But the time has now come to write legislation, and that can't be done with a committee of 400-plus. So the task force has been shrunk to a small core of folks charged with writing a bill and another, newly created advisory ,, group, whose job is to give the legislation one last critical look before it is made public.

In truth, I was not present when the health policy army was decommissioned. My son had a baseball game on the day I was to get formal word from my commander that my days as a Washington insider were over.

I decided to forgo the chance to stand on the White House lawn and bask in the gratitude of Hillary and Bill for giving them the benefit of my insights as to how to spend your tax money in favor of offering advice to 8-year-olds about the importance of keeping their eyes on the ball when fielding grounders. I told my son that there was no need to go back to Washington because the debate about health care is really only just about to begin.

Nothing has worried me more since leaving Washington than the level of anxiety that seems to exist among my friends and neighbors about health reform.

Those who are Clinton supporters, and even a few of his critics, seem genuinely concerned that the chance for real and necessary reform of our health care system is already slipping away. They look at me with doleful expressions and demand English translations of phrases such as "managed competition," "health care purchasing cooperatives" and "global budgeting."

My fellow Minnesotans seem sure that someone who spent many days getting lost in the Old Executive Office Building and who was once almost shot on the spot by a Secret Service agent for hiding in a small closet to write a memo while, unbeknownst to him, the president was preparing to hold a news conference in the room next door, can surely make sense out of the arcane phraseology that seems omnipresent in all the chatter about what is in store for the American health-care system.

And they seem convinced that they had better learn this new language fast, lest they be left helpless in the face of a newly imposed health care system.

The media are to blame for this collective anxiety. Editors and news directors tell their Washington correspondents to ferret out the details of "the plan." Reporters call and ask those who were on Hillary's task force in hushed tones if we can pass them any documents. I half expect to find Peter Lorre in my office tomorrow morning offering me a small fortune if I will only get him a copy of "the plan."

No wonder most Americans believe that a Star Chamber of policy wonks has hatched a secret scheme deliberately couched in incomprehensible jargon that a power-mad First Spouse intends to ram down the gullet of a hapless Congress before summer is through.

Forget it. A trillion dollars, the amount Americans will spend this year on health care, is a lot of money. With a seventh of the nation's economy hanging in the balance, the administration will not be able to impose a health-care plan on Congress or the American people. You will have ample time to learn all you could possibly want to know about health reform.

The stakes are so huge that it will take at least a year, more likely two, in order to hash out the specifics of what the country wants to do about its hospitals, clinics, nursing homes, insurance companies and drug stores.

America can expect a summer and fall brimming with town meetings, call-in shows, televised presidential sales pitches, newspapers brimming with pie charts and Sunday morning talk shows overflowing with heads blathering on about health-care reform.

Besides, there isn't going to be "a plan." No one is going to propose, much less enact, a single system for the delivery of health care in this country.

What the administration has in mind is better described as a framework or a set of ground rules for steering health care.

But, hey, there will be plenty of time to talk about the details of health reform in the months to come.

For now, relax, take in a ball game, tend to your garden, go fishing. Hillary and Bill are done listening to wonks, insiders and hTC experts.

8, They now have to start listening to you.

Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota.

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