Big Brother--Get the Heck Out of the Way : Clinton elates governors with new perspective

President Clinton, a former governor, has firsthand knowledge of the frustrations of making federal programs work at the state level. The problem isn’t that the federal government requires states to, for example, provide health care for the very poor; the problem has been that the federal government has sought to dictate precisely how states fulfill that obligation. Clinton is out to take the federal government out of the micro-management business. That’s a good idea.

Clinton has ordered the federal government to give the states more “elbow room” in administering health and welfare programs. Speaking this week to the National Governors’ Assn., which he once led, the President made clear that he knows that Washington has often played Big Brother, if not Big Bully, to the states, which are buckling under the burden of increasing health and welfare costs. States should be allowed to try new approaches. That means that the federal government must ease up on some restrictive rules that too often just don’t make sense. If federal money, for example, is specified for nursing home care, it’s difficult, and some say nearly impossible, to instead spend the money on in-home care--which is cheaper and preferred by many patients.

Governors, Clinton said, have long complained that the process for seeking waivers from federal rules is “Byzantine and counterproductive.” He added, “They are right.”

Clinton told the federal government to cut down the delays and the second-, third- and fourth-guessing that often accompany the waiver process. The move was widely applauded by governors, both Democrats and Republicans.

Even Republican Pete Wilson, who is trying to experiment with helping poor patients through “managed care” health maintenance organizations, cheered Clinton’s message. “To allow the states to innovate is going to make a tremendous difference,” the California governor said. “Traditionally . . . they’ve been quite bureaucratic.”

It’s true that cutting bureaucracy alone is no magic bullet for containing the cost of Medicaid--the federal program, administered through the states, that pays for health care for the poor and disabled. Some states project an immediate savings, but California officials caution against expecting a bonanza. Even so, innovation and the ability to tailor a program for the needs of a particular state are crucial in getting a handle on increasing public health care costs. About 25 years ago, Medicaid took up about 3% of an average state budget. Today, it now accounts for an average 14%. In California alone, the costs of the state Medi-Cal program--payments to doctors, hospitals, clinics, pharmacies and others providing care to the poor--have soared from $4.6 billion in 1985 to $14.3 billion now.

Of course it’s not the public sector alone that is staggering under the weight of health costs. General Motors announced it will take a $23-billion loss in 1992 primarily to pay for retiree health benefits. GM officials have noted before that employee health care costs can add almost $1,000 to the price of each vehicle.

That’s why Clinton’s attention to health care is so welcome and needed. His action to allow the states to use whatever creative resources they can to better manage health costs is just one small step toward reform. But enacting these sorts of reforms, small and big, are just the sorts of things Clinton was elected to do.