Health Care Marathon

March 06, 1994

Don't give up on health care reform. Although public support is waning as a result of the Harry and Louise TV commercials, although Republicans are exultantly pronouncing last rites, although Democrats are brawling with one another as is their wont, remember that legislation, like the weather, has its seasons.

Recently, days were gray and chill, but spring and summer and fall will come -- and so will health care legislation. It will be substantially different from what President Clinton proposed but will be reform nevertheless of a system that is widely perceived as failing to deliver on American standards of efficiency and fairness.

The health care issue has now passed through its rhetorical stages and has begun a tortuous journey through Congress. Already, one House subcommittee has given up hope of reaching consensus. However, another House subcommittee, -- this one part of the Ways and Means Committee -- will soon issue a proposal that holds to the essence of the Clinton program -- guaranteed private health insurance for all Americans -- but changes the elaborate government structure envisaged by Hillary Rodham Clinton's policy wonks.

Once all House committees have worked their will, the Democratic leadership will have to fashion a measure that can attract 218 votes, a majority. White House preferences will remain a consideration. But the main thrust will be on getting something that can pass. Then will come the Senate, a battle royal in itself, and after that a Senate-House conference committee where all previous bets are off and anything goes.

During this exhausting process, trial balloons will be popping like fireworks, interest groups will be lobbying vociferously and politicians will be nervously eyeing election day. Will Republicans dare to kill reform in its tracks? We doubt it. Will Mr. Clinton really veto legislation that offers some improvement but falls short of his benchmarks? We doubt it. What is likely to emerge is a giant compromise that will gradually -- perhaps quite gradually -- extend health insurance to the 37 million Americans who do not have it.

How mandatory the system will be, to what extent the government will impose price controls, which choices will be left to consumers -- these and dozens of other questions will have to be sorted out. Our guess is that the employer-employee mandate on health care costs will be closer to 50-50 than 80-20. Our guess is that alliances set up to pool insurance funds and bargain with providers and insurers will have a lot less authority than the president asked. Our guess is that minimum benefits packages will be slimmer and less costly.

But because, in the final analysis, the nation as a whole pays for everyone's health care, Mr. Clinton should wind up with a bill he can call a victory. And whatever its shape and shortcomings, it will be a victory of sorts after years of runaway medical spending and uneven health care delivery.

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