Hillary Clinton on Health: Right Person, Right Place : Reform: Task-force makeup leaves no doubt that coverage for all and control of costs are top Administration priorities.

By Inauguration Day, President Clinton had (almost) put together his Cabinet, but not his plans for the country. Health-care reform, as with proposals for economic stimulus and deficit reduction, had taken more time than promised to reflect the new President’s wishes. Yet the shape of what is to come in the reform of American medicine is now clearer: The President’s wife now heads the White House task force charged with delivering the Clinton Administration’s proposal within 100 days.

The appointment of Hillary Rodham Clinton to this responsible position should be good news to those favoring a fundamental reshaping of the availability and financing of American health insurance. It leaves no doubt that the universalization of coverage and the control of costs are top priorities of the Clinton Administration and that the President’s concept of reform, not that of experts or interest groups, will guide what he presents to Congress.

Not only is Hillary Clinton an able reformer, but she is also experienced in managing reform projects that are politically controversial, of great interest to ordinary citizens and central to her husband’s commitments. That much we know from the role she played in Arkansas, most conspicuously in heading efforts there to reform the financing and structure of Arkansas schools.

Most important, the task force appointment firmly locates responsibility and authority for the Administration’s health-reform proposal in the White House. The restructuring of an $840-billion industry belongs nowhere else. In American politics, where the question of whether there will be change is always fused with precisely what change is acceptable, controversial reform requires the full force of the single institution we have for articulating a unified purpose and vision of change: the presidency.

The road of American reform in medical care is strewn with failed but good intentions. For at least a year, the labels of competing “approaches” have dominated our public discussion: single-payer, play or pay and, more recently, managed competition. However useful these labels may have been to start the debate, they are now barriers to reform. They confuse more than clarify. They emphasize differences between approaches, not differences within them. They exaggerate differences among plans, not similarities across them. Moreover, the labels encourage development of warring camps, pitting symbol against symbol rather than realistic forecasts of what proposals might be like in practice.

In fact, the outline of what will emerge is reasonably clear. A workable but acceptable reform will draw together elements from all of the major proposals that are set against one another. Universal coverage and an expenditure limit--the traditional features of national health insurance--are almost certain to be proposed. Funds for financing health insurance will come from many sources, including the employers who are so central to the play-or-pay proposals. There will be room for managed-care plans and inducements to expand them, just as the advocates of managed competition have demanded. And the competition among hospitals, doctors and intermediaries will be shaped by changes in the regulations that universal health insurance requires.

None of this will be easy. On one hand, feverish lobbying by those whose incomes constitute our national health expenditures will raise every kind of fear--of rationing, of cruel bureaucracy, of limited choice, of runaway costs from yet another government program. On the other hand, experts claim that it would be virtually impossible to expand health insurance coverage without, as the Wall Street Journal put it last week, “resorting to fairly dramatic cost controls and finding substantial new sources of revenue.” Precisely. That’s why presidential leadership is required. Restraining medical inflation is the prerequisite both for expanding coverage and producing an economically acceptable fiscal-policy future.

What Americans want is a system of health insurance that covers everyone, is affordable for all of us and is free of confusing rules and rigid restraints on which doctor or hospital one can choose. Having Hillary Clinton as the President’s agent of reform makes a difficult task less so and gives us good reason to believe that this new Administration takes seriously its commitment to universalize coverage and to restrain the skyrocketing costs of care.