Clinton's Plan for Health Care

August 18, 1993

After months of waiting, the country has now glimpsed the broad outlines of the Clinton administration's health care reform effort -- and has also gotten a taste of the fight ahead.

In many ways, the reaction to President Clinton's speech to the nation's governors on Monday could have been scripted beforehand: critics charging that placing the burden on employers would destroy jobs, that payroll taxes would cripple the economy, that projected savings were imaginary.

Each of these criticisms -- and many others -- may well have a grain of truth. But if President Clinton is to succeed in his most urgent domestic initiative, his first challenge is to shift attention from the million-and-one reasons to criticize his plan to the larger issue of reform. He must convince the nation that the easiest thing to do -- to shoot down any reform effort and end up doing nothing -- is also the most dangerous.

As the president noted Monday, health care costs now account for 14 percent of the nation's gross national product, the highest in the world. With no significant changes in the health care system, that figure will rise to 19 percent by the end of the decade, making reform efforts even more difficult. Conversely, had health care reform been attempted a decade ago it would have been far easier than it is now.

But it's not enough to reform for the sake of reforming; there must be rhyme and reason to the plan. The administration's decision to retain and build on the practice of providing health coverage through employers is a disappointment to supporters of a stronger government role typified in a Canadian-style national health plan. But political realities made such a radical change unlikely to win approval in a country distrustful of government.

Employer-based coverage is not perfect, but it can work. "Managed care," a term heard frequently in the debate, also survives in the plan, with states given responsibility for organizing the groups that would collectively purchase health insurance.

Details about the plan are now outnumbered by opinions on its viability. But some of its proposals are long overdue, such as prohibiting insurance companies from denying coverage because of pre-existing medical conditions and removing an unfair tax penalty on the self-employed by allowing them to deduct the full cost of their coverage.

President Clinton admits to war-weariness from the long budget battle. But he seems to have learned some important political lessons. His speech signals the beginning of a concentrated effort to help set the terms of the debate, rather than letting opponents shape public perceptions.

That is wise. Health care is such a big part of the economy that change won't come until the public is persuaded it is more dangerous to do nothing.

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