Health care paradox may complicate politics



WASHINGTON -- There is an apparent anomaly in the public opinion polling data on Americans' attitudes toward reform of the health care system.

On the one hand, the polls show more voters oppose than support President Clinton's reform plan. On the other, there are clear majorities for such essential elements of the president's plan as universal coverage and some form of contribution from employers to help pay for it.

The findings may be less contradictory than they appear, however. The answer seems to be that most Americans want reform but not the Clinton version of reform. And what that suggests, in turn, is that the politics of the health care issue may be more complex than partisans on either side have been saying.

The conventional wisdom has been that senators and members of Congress running for re-election this year would have to decide either to identify themselves with improvements in the health care system or be seen once again as obstructionists creating legislative gridlock rather than doing the country's business.

The political choice obviously is not that simple, however. If the polls are accurate, it may be possible for Republicans to run against the Clinton plan specifically without being tagged as obstructionist in their attitude toward health care reform in general.

The operative factor here is Clinton's own standing -- that is, whether he has the clout with the electorate to make it politically wise for Democrats to ally themselves with his health care proposal. That might work in parts of the country, most obviously the Northeast and Midwest, where Clinton still gets positive marks for his general performance in office.

But in the South and parts of the West, the reverse is true. In these more conservative areas, Clinton's negatives are far higher than his positives. And it is in these areas, particularly in the South and border states, that the Republicans stand their best chance of gaining seats in the House. Professionals in both parties expect a Democratic loss of at least 10 seats and perhaps 12 to 15 in these regions.

There are other variables in the politics of health care. One problem for those being asked to commit themselves to significant change in the system is that the most intense demand for a new health care system comes from a minority of voters. One recent poll shows, for example, that 81 percent of Americans are satisfied with their own health care and 75 percent are satisfied with their health insurance.

The danger for the proponents of change is that these voters will be unwilling to take risks with their current situation. And it is that very uncertainty that the Health Insurance Association of America is exploiting with its new round of "Harry" and "Louise" television commercials that warn of the danger of "price controls" that could lead to rationing and of community rating that could lead to higher insurance premiums for younger people.

The commercials end with the message that "Congress can do better than that" -- a line of reasoning that a Republican might use to justify opposing the Clinton plan in particular but not the concept.

To some degree, of course, the political equities of the issue cannot be defined until we see the details of the legislation on which senators and representatives -- and their challengers, presumably -- will be obliged to take a position during the campaign later this year. Even a plan that phased in universal coverage over several years could be claimed as his own by the president so long as that universality were assured. If that can be accomplished without the controversial "employer mandate" to meet the costs of higher insurance premiums, it is even possible that, first, the bill could earn substantial bipartisan backing and, second, Clinton's standing with the electorate will improve.

It is also quite possible, however, that such a solution would take the health care reform issue out of the campaign because many voters are more interested in what candidates are going to do for them than in what they already have done. But finding that kind of a solution seems more difficult with every passing day, and time is running short.

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