Hard decisions will follow soft sell on health care



WASHINGTON -- The television commercials being run against President Clinton's health care plan are devilishly clever. But the fact that they are being run at all speaks volumes about the way business is done in Congress these days.

If you believe the civics textbooks, you might expect the members of the Senate and House to study this complex issue, then reach a considered decision on what kind of reform plan to write. That is essentially what will happen in the committees charged with the basic responsibility, the Senate Finance Committee and the House Ways and Means Committee. The committee system is a recognition that not everyone in Congress can be expert on every issue.

But perhaps the most unsettling change in the way Congress does its business these days is the way so many members react to public opinion polls, taking the temperature of the electorate before committing themselves on any issue with any visibility.

That reality, of course, is the reason health insurance companies have been running those commercials showing "Harry" and "Louise" and then "Louise" and her colleague at work "Libby" talking so reasonably about how, yes, sir, improvements in the health care system are needed, but "there must be a better way" than the Clinton plan.

The commercials are effective political advertising because they touch the right nerves -- the fear in the electorate of still another cumbersome bureaucracy and the fear that Americans will lose the right to choose their own physicians. Congress, we are assured, can find a better way.

The insurance companies are following a strategy used in political campaigns by fixing on those vulnerabilities. They can argue that the president is using the same approach from the bully pulpit by focusing on the most attractive features of his proposals -- comprehensive and universal coverage that is always there when you need it.

There is a fundamental difference. Although the White House may emphasize the most marketable features of its plan, it has been obliged to spell out the entire program, warts and all -- and thus open itself to criticism. The insurance industry commercials are selective enough to be totally misleading.

It would not be surprising if voters and viewers are confused about what and whom to believe. That confusion has been reflected in polls showing growing doubts about some features of the Clinton plan, although they do show general support for the proposition that significant changes are needed.

The operative question is to what degree, if at all, senators and representatives allow themselves to be guided by those poll findings as they look ahead to a midterm election Nov. 2 that is likely to come hard on the heels of decisions on health care.

It is fair to say that politicians cannot ignore the views of their constituents, although in theory they owe those constituents their best judgment on issues, not simply a reaction to poll numbers. The problem in this case is that the issues are so complex that the politicians must recognize they are not being given a fully informed opinion but one based on the sketchiest understanding of the way the legislation would work.

It is also fair to say that it is unrealistic to expect every member of Congress to become expert on every issue. They are clearly acting prudently if they solicit conflicting views from interested parties on all sides of such an issue, including those of lobbyists for health insurance companies. But they also have a responsibility to acquire enough information for the kind of informed decision their constituents have a right to expect -- not just a reaction to public opinion driven by commercials.

The use of television advertising campaigns to sway opinion on public questions, rather than just in election campaigns, has become increasingly common. Nor is it limited to one side or the other in the ideological wars. TV spots were used by liberal groups to drum up opposition to the confirmation of Robert Bork for the Supreme Court during the Reagan administration.

So now we have these attractive and reasonable people Harry and Louise and Libby sinking their sugar-coated barbs into the Clinton health plan. The commercials are polished and professional but no less misleading for being so. And the issue is too important for them to be taken seriously. As President Clinton likes to say, elected officials are hired to make decisions like this one.

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