Maybe best Clinton hope is to tar GOP on health



WASHINGTON -- Lurking behind the uncertain prospects for some salvation of health care reform as Congress returns is the big question for President Clinton: Assuming some "incremental" legislation manages to pass, will he or won't he sign it?

Although he has not openly abandoned his State-of-the-Union pledge to veto any plan that fails to cover every American with insurance that can never be taken away, he has already fudged on the question of timing.

The utterings of both the president and the first lady over the summer have been marked by the hedge that any bill must be "moving toward" universal coverage to warrant his signature. That is a very wide loophole through which he can drive if he chooses.

Beyond that, the political realities dictate that he take whatever he can get now. Midterm congressional elections are approaching that by tradition will cost the president's party losses in the House and Senate, possibly of considerable dimension. He isn't likely to get any more on health care reform from the next Congress than he can squeeze out of this one.

So sweeping was the reform that the Clintons first proposed that at least in retrospect it was inevitable that it would marshal a horde of determined and well-heeled special interest opposition. Failure to deliver on so ambitious an undertaking should not obscure the fact that President Clinton placed health care reform squarely on the national agenda and forced Congress to confront it.

Many Republican legislators who earlier refused to acknowledge any health care crisis are now at least weighing possible political damage to their re-election chances if they don't accept some modicum of reform. Clinton should seize on that attitude.

There is general agreement in both parties that insurance companies at a minimum should be obliged to sell coverage regardless of a person's pre-existing medical condition, and that workers should be able to keep their coverage if they lose or quit their jobs. At least these features should be enacted, assuming they are feasible short of universal coverage.

It has been argued here and elsewhere that at the core of Clinton's political troubles is the public impression that he can't be counted on to stand firm on important matters. That argument would seem to call for him to carry through on the one conspicuous veto threat he has made as president.

But in health care reform his failing has not been so much in not standing firm as it has been in his misgauging of the opposition he would encounter to historic proposals affecting so many aspects of the national life and economy. If Congress manages somehow to salvage something from the long, complicated and painful health care reform debate, it will be a waste of all that has gone on this year if Clinton elects to walk away with nothing, just to keep a pledge he probably never should have made.

Again from a political point of view, carrying through on the veto would enable the Republicans who presumably would have cooperated on forging a minimal reform package to accuse Clinton of rejecting bipartisanship and hence assuring continuation of congressional gridlock.

The choice for the president may come down, at best, between accepting half a loaf or even much less and eventually getting some credit for breaking the ice on health care reform, and demonstrating his "toughness" -- while underscoring his failure -- with one high-profile gesture.

It seems indisputable now that the Clintons have been correct all along in arguing that unless all Americans are covered, national health care costs will continue to rise, as the young and unsick opt out and the poor, ill and elderly further tax the system's resources. But they do not have to retreat from their basic premises in facing the political reality.

Although enactment of any health care reform undoubtedly would lower public pressures and interest in achieving more in the next session, Clinton would be free to continue to try, while painting the Republicans as obstructionists. And that, in the end, may be the best he can hope to salvage from his great first-term legislative dream.

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