Can Clinton do an FDR?

August 16, 1994|By Alan Brinkley

AFTER 18 months in office, the Clinton administration finds itself in a bizarre political condition.

It is so beleaguered -- even the crime bill was rejected in the House last week -- that Bill Clinton's own pollster is encouraging Democratic candidates not to identify themselves too closely with him this year.

Yet he also is agonizingly close to a monumental policy achievement.

A long dreamed of national health insurance program -- uncertain as its prospects remain -- is closer to reality than it has ever been.

No domestic proposal since the Social Security Act of 1935 would affect the lives of so many Americans. And unlike Social Security, health care legislation will pass -- if it does -- over the strenuous opposition of an extraordinary range of well-financed and ferociously active interest groups as well as Republican foes.

Any plan Congress approves will only faintly resemble the complicated proposal the president submitted. But that will not prevent him from receiving the lion's share of the credit (or blame) for the result.

Franklin D. Roosevelt had little to do with drafting the Social Security Act. Yet it's linked to him.

The pressure for health care reform comes from many places and was building well before Mr. Clinton embraced the issue. But if a serious program is enacted, it will be his achievement more than anyone else's.

No president has staked so much political capital on universal BTC health care; that Bill Clinton has done so, so steadfastly, is all the more striking because he has so little capital to spare.

For that very reason, the battle reflects his considerable political weakness. He has been criticized for a lack of firmness and commitment. He will be strongly tempted to veto any bill that does not guarantee universal coverage.

But he also badly needs a victory and will be tempted to accept almost any package that substantially expands coverage. Both temptations pose dangers.

The history of the Social Security Act of 1935 suggests the risks of making an excessively rigid commitment to universal coverage.

When it was enacted, its benefits fell much further short of universality than almost any health care measure now debated. Huge categories of people were excluded.

The Social Security Act was successful because it established the principle that Americans were entitled to certain social protections. That principle quickly produced popular demands for continued expansion of the system.

Surely, legislation establishing the principle but not the reality of universal health care would similarly generate substantial public pressure for expansion.

On the other hand, the 1965 Medicare Act illustrates the dangers of establishing a principle of entitlement without an adequate structure for financing and containing it.

President Lyndon B. Johnson believed, correctly, that once he established the principle of a right to health care for elderly people, it would be impossible ever to rescind it. But he established no effective mechanisms for controlling the costs, and by the late 1970s they were growing at a phenomenal rate.

Later efforts to contain them led to a shifting of economic burdens to other groups of recipients, driving up insurance premiums for people under 65 and helping to push many out of coverage altogether.

The unintended consequences of Medicare are among the causes of today's health care crisis. And they support Mr. Clinton's argument that a system too far from universality could make things worse, not better, for people who need help the most.

The president faces the unenviable task of balancing these conflicting legacies -- from a position of political weakness. The result will, no doubt, be far from perfect.

But it seems reasonable to expect him to insist that any legislation at least create a path toward an effective system of universal coverage (as the Social Security Act did) and not a route to crippling imbalances in the cost of health care (as the Medicare bill inadvertently managed to do).

If he can achieve this, the controversies swirling about him are likely to seem as ephemeral in the end as the long-forgotten partisan squabbles of 1935.

Alan Brinkley, professor of history at Columbia University, wrote this for the New York Times.

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