Clinton sees health reform as test of U.S. resolve President cites 'magic moment' for U.S. problems

September 21, 1993|By Carl M. Cannon | Carl M. Cannon,Washington Bureau Nelson Schwartz of the Washington Bureau contributed to this article.

WASHINGTON -- Tomorrow night, President Clinton will explain why he believes it is necessary to reform the nation's health care delivery system -- a massive overhaul of one-seventh of the nation's economy.

His aides have already asserted that this initiative is the "defining issue" of the Clinton presidency, but he indicated yesterday that in his mind the stakes are even higher:

The nation is at an historic "magic moment" in which the battle over health care will reveal whether the United States has the will to confront its deepest problems, asserted the president, flanked by former Surgeon General C. Everett Koop, as he met with influential physicians.

"This is really a part of a great national discussion we have to have about what kind of people we are and what kind of country we're going to be," Mr. Clinton said. "We can't really get the kind of health care system we need until there is a real renewed sense of responsibility on the part of everyone in this system."

If the country can tackle health reform, no problem would be beyond solution: teen-age pregnancy, crime, or any of the other "destructive group behavior that is tearing this country apart," he said.

In an extraordinary year and a half, Mr. Clinton has peddled himself and a dizzying array of ideas and concepts to the American people, but nothing as personal to voters as their relationship with their doctors and the health of their families.

"It's been a long time since there has been a proposal this universal, something that touches everyone," said Stephen Hess, a fellow at the Brookings Institution in Washington. "This is the broadest program since President Eisenhower created the interstate highway program in the 1950s."

Other historians invoke the great social agendas of the New Deal or the Great Society. Whatever analogy is used, the way presidents sell big change tells as much about the nation as about the presidents who led it.

During the Cold War, Dwight D. Eisenhower used the threat of communism to convince citizens to spend hundreds of billions of dollars on modern roads.

During the Depression, with one-fourth of the nation out of work and little but charity available for millions in need, Americans knew the problem. So President Franklin D. Roosevelt used understated language in 1935 when he proposed the creation of Social Security to ensure "the security of the men, women and children of the nation against certain hazards and vicissitudes."

Thirty years later, President Lyndon B. Johnson introduced Medicare boldly promising: "No longer will older Americans be denied the healing miracles of modern medicine."

The success of Mr. Clinton and his top adviser on health care, first lady Hillary Rodham Clinton, will depend on their ability to marshal their arguments to a public often unwilling to pay for the services it demands, to a Congress most preoccupied with re-election and to a powerful health care establishment worried about profits.

VTC A sign that the Clintons may be in sync with the public's mood came yesterday when the prestigious, 80,000-member American College of Physicians endorsed Mr. Clinton's plan even though it termed the component on malpractice reform "weak" and inadequate.

But Mr. Clinton has repeatedly signaled a willingness to compromise on such details, a response to a lesson learned during the costly, one-vote victory on his budget package.

During the budget battle, Mr. Clinton personally negotiated every fine point of his budget bill with strategically placed members of Congress -- some of them very junior -- who then crowed that they had backed the president down.

As a result, every compromise that was made appeared to be a Clinton administration defeat. Thus, public attention focused as much on what Mr. Clinton didn't get in his budget bill as what he did get.

This time around, the president, is painting with a broad brush. And so, the president plans to take his case to the people in a nationally televised speech to a joint session of Congress by outlining broad principles and themes, emphasizing that:

* Even Americans who now have health insurance don't have much security.

* Workers who can't change jobs because of "pre-existing" health problems are frustrated from realizing their dreams.

* The health care system is bogged down in needless paperwork that keeps doctors and nurses away from patients.

* Those now uninsured get the care they need eventually, but often in expensive emergency rooms, forcing hospitals and doctors to pass the cost on to others anyway.

Finally, the president will stress the need for everyone from pharmaceutical companies to small business people to put aside their parochial concerns for the greater good.

"If we can give the security of decent health care to every American family, it will be the most important thing that the government has done . . . in a generation," Mr. Clinton said.

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