Health reform has its own life

Robert Reno

September 24, 1993|By Robert Reno

NOW THAT President Clinton has finally lifted the lid off his health-care reform program, we can see that it is top-heavy with contingencies that present a broad target to its enemies.

And so we move to the next stage, in which progress in health care reform as well as the success of the Clinton presidency will be measured -- daily, tediously, incrementally and to the great trial of our patience -- as this great beast lumbers through Congress and its committees, having pieces of its carcass ripped and shredded by the interests who find offense in this part, a threat in another part, a general odiousness in the whole or who merely have a political disposition to deny the president any kind of victory.

This will be a depressing process if you let yourself believe that real reform in the American system is ever as simple as the president proposing a law and the Congress disposing of it.

A more refreshing view of the process was voiced this week by C. Everett Koop. He is to be remembered, of course, as the surgeon general who taught the Reagan administration everything it didn't want to know about sex and was too pig-headed to ask, the man who made the word condom permissible in political dialogue. There was this bearded Reagan Republican at the White House Monday articulating what spin doctors had failed to perceive -- that health-care reform -- or the presidency itself, for that matter -- is not a ballgame.

The president, said Dr. Koop, has "accomplished more in health care reform in the past four months than all his living predecessors put together."

Would that we could be sure the president understands this. If you view health-care reform as a change in national attitudes, as the unleashing of inertial forces that move with maddening, almost slovenly hesitation, then we may, as Dr. Koop suggests, be much further along the road to a saner system than most of the media scorekeepers and presidential poll readers imagine.

Already, at least 10 states have moved independently toward a more aggressive approach to cost management. The rate of increase in total health-care costs began slowing months ago as various providers started getting the message that they should do for themselves what was about to be done to them.

Even the American Medical Association has begun to find elements of the status quo that it can live without. Surely the insurance industry has been scared into a less obstructive position. Cuts in the Medicare system that would have been politically unthinkable two years ago are now a standard part of anybody's health-care package. The public is much better informed about the policy alternatives. Hillary Rodham Clinton's work in the health-care cause has earned her a level of credibility that the president might envy. She may, for all we know, understand better than almost anybody alive the risk that this plan may be but a preliminary step toward the inevitable -- a simple, universal, single-payer, Canadian-style system.

Anyway, even if the president's program gets hopelessly bogged down, the process of reform has already gained a life of its own.

Robert Reno is a columnist for Newsday.

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