The 'debate' is missing in health care debate



WASHINGTON -- You could argue that the health insurance reform question has been part of the national debate for at least the two years since the New Hampshire primary campaign of 1992. It has clearly been center stage since President Clinton delivered his health care message to Congress and a national television audience last September.

But a new Washington Post-ABC News opinion poll shows that only 24 percent of Americans claim to know a lot about President Clinton's plan, up only marginally from the 17 percent who made the same claim last October just after his speech.

Meanwhile, reservations about the president's plan have trended steadily upward, to the point that 48 percent of Americans disapprove of it compared to 44 percent who approve, the first such negative rating.

It also is obvious that specific concerns have risen steadily. Those who believe the quality of their medical care would decline under the Clinton plan have risen from 64 percent to 80 percent in these five months and there are clear majorities of people who question the cost of care, the choices they will be offered, the availability of services, the loss of jobs and the creation of another large bureaucracy to administer the plan. The only mildly encouraging sign for the White House is that those who believe "taxes will have to be raised to pay for the plan" have declined from 68 percent to 62 percent.

In other words, it is now apparent that the critics of the plan have succeeded in raising pervasive doubts about it while the administration has failed abjectly in making a case for its plan.

Some of the White House's failure can be traced to events beyond its control. Although the president has made repeated attempts to get the electorate's attention focused on specific aspects of his plan, other significant stories have crowded health care onto the back pages. The White House, meanwhile, has been less than deft in making its case for health care reform in any consistent, forceful and effective way. There has been the episode of the television commercial misrepresenting the position of Gov. Carroll Campbell of South Carolina. There has been an embarrassing failure to enlist the American Association of Retired People. There have been zigs and zags in political strategy on such basic questions as whether to enlist or attack Senate Minority Leader Bob Dole. In the end, however, the failure Americans to have a clear view of the health care issue has less to do with the inadequacies of the White House than with the way the political system and press operate .

It is obvious, for example, that the health insurance companies, business organizations and some Republicans have been successful with television commercials and repeated statements that touch on all the potential doubts about such a drastic change in a basic service. Americans are afraid of losing their present level of care and their choice of physicians, of paying more for their insurance and of being victimized by more inefficient government.

These commercials and sound bites on television news programs could never be considered even marginally informative or educational. But Americans have become accustomed to forming their opinions on the basis of such snippets of information. And TV simply lacks the capacity to deal with complex issues.

By contrast, most responsible newspapers have carried endless stories on the controversies over this feature or that feature of the Clinton plan. And most have published comparisons of the president's proposals with the so-called Cooper Plan and the single-payer plan being discussed in Congress. But no one in the newspaper business kids himself about how many readers are serious enough to read and digest them.

It may turn out, of course, that the more Americans come to know about the Clinton plan, the more they will reject it and apply pressure on Congress to do likewise. That seemed to be the case with the poll sample.

But, at the least, the president and his plan -- and those competitive proposals in Congress -- deserve serious consideration. After two years on the national agenda and five months ostensibly on center stage in the national debate, that hasn't happened.

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