President John F. Kennedy once said that "victory has a hundred fathers and defeat is an orphan." The defeat of President Clinton's health care reform proposal, however, has more than its share of fathers. White House mismanagement of the whole issue, TV ad attacks by special interest groups, Republicans out to stymie the administration -- the list can be as long as the issue is complex.
Though Mr. Clinton's "defining" initiative failed of passage, it kicked off a massive learning experience that is already shaking up the nation's health care system. The rate of increase in health care costs has been cut in half in the past year. States are moving creatively to widen health insurance coverage and bring runaway Medicaid costs under control. Market forces reflecting an excess of hospital beds and doctors are forcing efficiencies and radical changes in the way health care is delivered.
Add to this the very real possibility that a new Congress will pass health reform legislation that reflects a consensus in favor of incremental rather than comprehensive changes. For example, solid support has developed for health insurance that cannot be denied to citizens because of pre-existing illnesses or disabilities or because a worker is switching jobs. Extension of benefits to pregnant women and children has become an idea whose time is not far off. Teaching hospitals have won wider understanding for the extra financial burdens they bear in a fiercely competitive market.
Until the Nov. 8 elections, health care will be smothered in politics. Republicans will charge that the Clinton proposal was too complex, too bureaucratic, too ambitious to be acceptable to the 85 percent of Americans who have health insurance and like the status quo. Democrats will argue that GOP obstructionism blocked a great opportunity to extend coverage to all Americans in ways that could help control budget-breaking costs.
That there is a degree of truth in both positions is a positive factor that could pay dividends with later Congresses. The Clinton administration is in a retrenchment mode, with Hillary Rodham Clinton cutting ribbons rather than cutting up insurance and pharmaceutical companies. The First Lady may now realize that the key to legislation in Washington lies in making friends, not enemies, and in writing legislation as a cooperative effort rather than in handing it down from on high. Republicans, who anticipate big gains this year, are careful not to express opposition to health care reform, per se. The higher their numbers in the next Congress, the more will be the pressure to produce rather than indulge in gridlock.
Just as it took years to pass Social Security, it will take more time to reform a health care system that accounts for one-seventh of the U.S. economy. When the subject has been adequately thought through, when the public is educated rather than apprehensive, when the politics of the situation produces the necessary impetus for action, health care reform will become a reality.