Toward a Deal on Health Reform

July 21, 1994

Is President Clinton preparing to cut a deal to save health care reform, or isn't he? Is the message he delivered to the nation's governors this week straight goods or a garble? If it is a garble, was it deliberate or inadvertent?

Our hunch on all three questions is yes and yes and yes. Yes, the president is very much in a deal-making predicament as health insurance legislation hobbles toward a decisive stage. Yes, his message -- conveying flexibility, a willingness to give on requirements that employers pay 80 percent of insurance costs and his acknowledgment that "universal" coverage in reality can add up only to 95 or 96 percent of the population -- was straight goods. Yes, his self-proclaimed "communicative skills" may have misfired, but the resulting garble has its uses at this stage of the game.

At the end of the day, there is still a chance Congress will enact a veto-proof bill for the very political reason that incumbents of both parties have reason to fear voter reaction if they gridlock. A New York Times poll indicates that 79 percent of the population considers universal health coverage "very important" and 69 percent would be "disappointed" if no legislation were to emerge.

Just what did the president say in Boston? He wouldn't "rule out a health bill that didn't have an employer mandate if we knew we were moving toward full coverage." He would accept "a phased-in deliberate effort" to provide coverage of "somewhere in the ballpark of 95 percent upwards." All this to assuage the Senate, though at risk of confounding his troops in the House.

Mr. Clinton has always known that his State of the Union vow to veto any bill that did not "guarantee every American private health insurance" was political blather. Even Social Security covers only 98 percent of the population. So when you get down to bargaining over a projected, wholely unverifiable guess of 95 or 96 percent coverage in the year 2000 or 2002, you are talking about classic sleight-of-hand compromise.

Whether this is to be achieved by setting up a "trigger" mandating employers or individual citizens to pay up at a future date is something for later Congresses to worry about, no matter what we hear from current incumbents. In the meantime, there may be an emerging consensus for relatively modest reforms in private insurance practices to require coverage regardless of pre-existing health conditions or change of employment.

The governors accomplished much by letting Mr. Clinton know they would not endorse employer mandates and by delivering a bipartisan rebuke to Senate Republic leader Bob Dole's scheme to finance health insurance reforms and subsidies by dumping more Medicaid costs on the states. Now it is up to the Washington fraternity to devise a financing plan that works and is not a fraud put together to get past the November elections. This was Mr. Clinton's most important message in Boston; it also may be the most difficult obstacle of all.

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