The Clinton Health Plan

September 16, 1993

Even before its formal unveiling next week, the Bill and Hillary health care reform plan is the standard against which all other proposals -- and there will be a lot of them -- will have to be judged.

The president and the first lady have labored long on one of the most ambitious social overhauls in American history. It is already attracting tough criticism but also cautious acquiescence from such major players as the American Medical Association and the American Hospital Association. An alternative blueprint offered by moderate Senate Republicans reveals ample room for compromise.

If health care reform is to be the defining issue of the Clinton presidency, it will first have to pass the Congress in some form. And that raises institutional questions about the legislative branch: whether its cross-hatching of turf-jealous committees and subcommittees is capable of handling so complex a measure; whether its penchant for partisan struggle will lend itself to accommodation among powerful interest groups; whether its fear of public opinion will push it to a lowest-common-denominator approach -- or perhaps gridlock.

Yet before the legislative branch tries to get its own house in order, the executive branch had to prove itself capable of dealing with a health care system in which soaring costs are harming the nation's economy while millions remain uncovered by insurance and/or poorly served.

The Clinton plan is too sweeping, too revolutionary, too loaded with controversial assumptions and theories to deserve quick acceptance. A national debate is in order. The 37 million workers who now receive no health insurance from their employers already know much is wrong. But most citizens are covered and reasonably satisfied. They are skeptical of administration claims that no new taxes, other than a $1-a-pack levy on cigarettes, will be required.

The administration has reacted to this political dilemma by crafting a proposed system that supposedly will take nothing away from the satisfied majority while providing universal coverage and access to health care for the working poor. This step is bound to produce winners and losers, and some are already being heard from.

Health care providers will be subjected to cost controls; health insurers will be shoehorned into networks in which only the largest will survive; big companies that already provide substantial benefits may see a leveling out of a soaring cost curve; small employers face mandatory insurance requirements that many cannot afford; Medicare and Medicaid recipients over time will feel the effects of a government down-hold designed to cut rising costs by $300 billion-plus over five years.

President and Mrs. Clinton deserve credit for grappling with a problem which drew only lip service from most of their predecessors. The administration plan is far from the final answer. But it is a required first step if this country is to develop the health care system it deserves.

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