In comatose mumble: Set for a mess over health care

February 08, 1994|By Russell Baker

ALL the ingredients are in place for the making of another fine mess in the best Laurel and Hardy tradition.

First, almost every politician in Washington needs something that can be called a "health-care bill" and needs it quick. In time for autumn campaigning, in fact.

Second, there is no consensus in Washington about what this wondrous "health-care bill" should do or be.

Third, there is no pronounced sentiment among the public either about what a "health-care bill" should do. This is because the public has only the foggiest notion of what's on the table.

Fourth, this absence of public understanding means the real power to write the bill rests with lawyers, social engineers, insurance companies, medical and drug lobbies, corporate managers and the political action committees, or PACs, which now finance most politicians' campaigns.

The first thing to be noted about these people is that they are of the class that is least inconvenienced by the shortcomings of the present health-care system. Though doubtless decent citizens all, they would be inhuman if, feeling little personal need for urgent change, they didn't use their special leverage to protect their own interests.

Last Wednesday, for example, the Business Roundtable, consisting of top people in some 200 of the country's biggest companies, threw their considerable weight against the Clinton bill. The Roundtable "task force" that drew up this position was headed by the CEO of Prudential, an insurance business.

Fifth, the White House strategy from the outset has promoted public confusion -- which breeds public indifference -- about its own plan. This could be fatal, because attempts to create great changes in American life need maximum public enthusiasm to overcome Congress' natural inertness.

"An idea whose time has come," Sen. Everett Dirksen said when overwhelming public pressure finally broke his Republican coalition with Dixiecrats, forcing an end to racial segregation.

Without public passion behind it, the Clinton plan was bound to get rough treatment from insiders whose interests tend to be more specialized than those of, say, a self-employed carpenter supporting a family of four with a troubling health record.

From the start, the Clinton plan never felt or smelled like a great idea whose time had come. Just the opposite. There were so many little ideas embedded in it that it was hard to find one that stirred the juices.

Hindsight is easy, of course, but the famous closed meetings with all the world's best-informed health-care experts didn't look like a great idea to begin with.

Experts love details; the rest of us are too busy with the details of living to be carried away with enthusiasm about the experts' detailed ingenuity.

Often we are content to be rabble yearning to be roused. Amazing technical constructions like the gigantic (1,362 pages) health-care bill the Clintons finally produced do not stir the blood.

And so while experts marvel and dispute, all sensible humanity slumbers, leaving the boys in tasseled loafers free to have their way with the pols.

What the Clintons needed was a drawing by Eero Saarinen. What the experts gave them was a blueprint by Rube Goldberg.

In retrospect it seems clear that the wise way to start would have been to come out for the simplicity of the single-payer plan. Of course it would have produced political uproar, and a healthy uproar it would have been.

At least it would have set pulses pounding. Awake, we might have advanced further than we're moving in this comatose mumble of experts about whether the Cooper bill is better than the Clinton bill and how fast the bile should be permitted to flow before the insurance company cancels your policy and whether . . .

If they'd started with the single-payer proposal, the Clintons could have negotiated back to something that would have saved the insurance industry's stake in the business without losing important points like universal coverage.

Instead, their experts gave the game to the insurance people at the start, thus surrendering a big, big bargaining counter.

The best thing might be for health care to be scrapped this year, so a fresh start can be made another day. The pols, however, need something they can call "health care," no matter what it does. Prognosis: Looks like Laurel and Hardy time again.

Russell Baker is a columnist for the New York Times.

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