The Suspicion of a Consensus : Health care: Maybe reform is actually possible

What a difference an issue makes. During the budget battles in Washington, the Republicans--and more than a few Democrats--were fighting the Clinton Administration at every turn. But with the seemingly more volatile issue of health care reform now on Capitol Hill, it turns out that the divide between President Clinton and Congress is not as wide or as deep as many had predicted. At least so far.

It’s no secret why: Politicians know that health care is an issue that hits home with voters. It’s not in the interest of any party or group to appear obstructionist when it comes to reforming a health care system that works well for only an ever-shrinking number of Americans. Thus, so far, there are broad points of agreement between Clinton and congressional leaders on how health care reform should work.

COMMON DIAGNOSIS: Both Republicans and Democrats agree that the pell-mell system that exists--some Americans covered by Cadillac insurance plans that are too heavily subsidized and overused, many others with paltry insurance plans that don’t cover many medical and hospital needs, and 37 million with no insurance at all--is unacceptable and must be changed. They agree that health care consumers must band together in large alliances in order to gain purchasing clout with insurance companies, physicians and other, as the jargon goes, “health care providers.” That’s an important point of agreement, contained in an alternative GOP health plan endorsed by 22 Republicans in the Senate, half the GOP membership. In addition, everybody has jumped on the bandwagon of cutting waste and fraud and simplifying paperwork.

Even two senators rarely known to see eye to eye, Sen. Edward M. Kennedy (D-Mass.) and Senate Minority Leader Bob Dole (R-Kan.) used similar words in speaking of reform. Kennedy said the alternative GOP plan indicated that “bipartisan cooperation is not only possible but probable in this all-important debate.” Dole predicted that “what will ultimately emerge . . . is a bipartisan plan that will address the needs of the American people.”

DIFFERENT MANDATES: Of course there are also key differences. The biggest one is that Republicans don’t like the requirement in the Clinton plan that employers provide insurance for all employees. They instead favor requiring individuals to obtain their own health insurance; some who could not afford insurance would receive vouchers from the government. That’s a proposal that many Democrats suggest is too burdensome on the individual.

But all this is the stuff of which political compromise--and legislation--is made. And that brightens the prospect that Washington actually could reform the nation’s health care system sometime next year. Imagine.