Health Care Revolution

September 22, 1993

Franklin D. Roosevelt and Social Security. Lyndon B. Johnson and the Great Society's Medicare-Medicaid programs. Now Bill Clinton and his daring, sweeping proposal to provide universal health care to the American people.

There will be a sense of history tonight when the president appears before Congress to invoke a dream that has eluded and often intimidated his predecessors. He is calling for the enactment of legislation that will guarantee all Americans basic health services no matter what their economic status or their past and present medical condition.

This will require vast and costly changes in the way doctors, hospitals, nursing homes, insurance companies, HMOs, pharmaceutical firms and others conduct an industry that consumes one-seventh of the U.S. economy. It will force all employers, including those who presently leave 37 million workers uncovered, to provide insurance for health services at government-mandated levels.

President and Mrs. Clinton have heard Senate Finance Committee chairman Daniel Patrick Moynihan call their figures "fantasy." They have suffered cruel comparisons to the smoke and mirrors of Ronald Reagan. They have taken the punches of liberals enamored of a system in which the government pays for all health services and of conservatives who warn the administration is about to impose a stifling layer of government regulation and control on the free market system.

Yet amid all the cat-calls, something curious may be happening. Democrats and Republicans in Congress came out of their furious budget battle so wounded in the eyes of their constituents and in their relations with each other that they may seize on health care reform as a vehicle for good works. Republicans are offering alternative plans, but assert a willingness to cooperate. Important segments of the health care industry are giving guarded support. And the Clinton White House itself professes a willingness to accommodate.

If it leads to sound and serious reform, well and good. But if in the long journey through Congress the reforms are whittled down or so underfunded that failure and breakdown are only a matter of time, then the present exercise will be a hoax.

This newspaper is pleased that the administration has chosen to build on the employer-provided health insurance system that is already in place. We also applaud its efforts to meld competitive market forces with necessary government controls and guarantees of universality. What is troubling is whether there are sufficient financial underpinnings for such an ambitious revolution.

As a year-long fight for passage begins, we urge the president not to retreat from the basic goals he will outline tonight. As Mr. Reagan's surgeon general, C. Everett Koop, declared this week: "He [Mr. Clinton] has accomplished more for health care reform in the past four months than all his living predecessors put together." The president has people's attention; now he needs to win their support.

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