CBO health plan report was not huge disaster



WASHINGTON -- The report from the Congressional Budget Office gives some heavy political ammunition to Republican critics of President Clinton's plan for reforming the health-care system. To the surprise of absolutely no one, they are braying that the CBO study proves Clinton is plotting a massive tax increase to finance a huge government entitlement program.

There is an obvious market for the critical rhetoric. One of the things that shines through the opinion polls these days is that Americans want better health care for everyone but are not willing to pay for it either through higher insurance premiums or taxes. Let's have something for nothing.

Moreover, Clinton probably cannot get away with dismissing as "a Washington policy wonk deal" the CBO finding that the plan must be considered part of the federal budget and would increase rather than decrease the deficit in the years immediately ahead. These are not issues of concern only to policy wonks.

But it also would be a mistake to take seriously the ranting of Newt Gingrich, the House Republican whip, who with his usual hyperbole depicted the CBO analysis as evidence that the Clinton plan is "dead on arrival."

In fact, although the White House has suffered some tough hits in the last week from business groups and the CBO, Clinton still is positioned to earn an enormous political credit from the health-care issue in the long run. He is the one who has put health-care reform on the agenda and, up to a point, defined the terms of the debate.

With a few exceptions, Republicans and conservative Democrats already have joined in supporting two significant reforms: portability, meaning a guarantee that an employee can take his health insurance protection from job to job, and coverage for those with pre-existing medical conditions who now are often denied insurance. And most Republicans have also committed themselves to the principle of universal health-care coverage, although disagreeing with Clinton on how it can be achieved and financed.

Thus, if the final product from Congress is a bill that provides that portability and pre-existing condition coverage, Clinton will be able to use whatever definition he chooses for "universal" and declare victory.

Taken as a whole, the CBO report was far from calamitous for the White House. The analysis did find, as Clinton has argued all along, that eventually -- five or six years later than he forecast -- there would be savings in health costs from his proposals. And the definition of the added "tax" burden upon which the Republicans have seized is subject to this question: If the added insurance premiums business would have to pay under the Clinton plan represent a tax increase, why shouldn't the lower premiums some workers will pay be considered an offsetting tax decrease?

In a sense, the administration may have set a political trap for itself by minimizing for obvious political reasons the initial costs of the conversion to a new system. Universal health-care coverage necessarily means providing for a substantial underclass of Americans not now covered or easily reached because they have no regular employers.

The president has pointed out repeatedly that Americans already are paying for health care for these people one way or another, through the costs of maintaining emergency room services in hospitals or through responsible employers paying higher insurance premiums than would be required if everyone paid. But that element of the case for reform has not been made effectively enough to counter the fears that the Clinton plan will produce massive bureaucracy and runaway costs.

The Republicans also have seized on the CBO finding as evidence that Clinton is not a "new Democrat" at all but another in that long line of "tax and spend Democrats." There is some validity in that argument in that Clinton is trying to use government as an instrument for significant social change far more than "new Democrats" might approve.

But all these arguments miss the point. Congress is facing a decision too important to be made on the basis of who scores the most political points every week.

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