Health First, Welfare Second

January 24, 1994

One political hot button President Clinton will push in his State of the Union address tomorrow night is welfare reform. But how hard he will push it is a subject that has triggered policy debate in Washington and again revealed the deep ideological divide in Democratic ranks. Liberals and centrists are battling one another as vociferously as they did during the trade battle over NAFTA.

In this fight, if only for tactical reasons, Mr. Clinton seems to be on the side of the liberals in wanting to concentrate all his fire power on health care reform. This suggests any real push to shake up welfare may be put over till next year, a timetable that would play into the hands of Republicans in the November elections.

Sen. Daniel Patrick Moynihan, D-N.Y., chairman of the Senate Finance Committee which has jurisdiction in both areas, got the administration's attention the other day when he said, "We don't have a health crisis in this country; we have a welfare crisis." This assertion has the flash of truth reminiscent of Senator Moynihan's warning three decades ago that welfare dependency was destroying the black family. Teen pregnancy, drugs, crime and poverty are all inter-connected.

While the welfare crisis is undoubtedly urgent, it is not the alluring middle-class entitlement that universal health care could Rather, it is a lower-class entitlement defended mainly by those whose careers are tied to a system that is widely regarded not only as a failure but as something worse: a government mechanism that entrenches the very societal ills it is designed to cure.

Candidate Clinton caught the public mood with his vow to get rid of "welfare as we know it," a slogan that deftly finessed and embraced the class and racial resentments that add to the rancor of welfare politics. He would put a two-year limit on welfare aid, he said, and insist that recipients prepare themselves for the work force.

The irony, however, is that welfare reform will cost money, not save money. Estimates range as high as $10 billion a year to

finance the job training, child care, transportation and pay subsidies implicit in the Workfare approach. And because of budget constraints, such sums could be found only in taking money from competing social programs.

While the administration wrestles with the devils in these details, the Clinton folks say health care reform can be a "building block" for welfare reform by making funds available from cuts in Medicaid. There is little other give in the budget.

In the perfect bureaucratic kingdom, this logic is unassailable. But in the political arena, the public wants to stop a system that subsidizes self-destructive behavior. Republicans have a bill drawn up and are raring to go on this issue. It has built-in explosives. No wonder former secretary of Health, Education and Welfare Joseph Califano calls welfare "the Middle East of domestic politics."

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