The halls of Congress will soon be alive with talk of managed-care competition, HMOs, PPOs, health alliances, the single-payer system and lots of other bewildering acro nyms and phrases forming the de bate on how to reinvent America's health-care system.
The stakes are huge. One in every seven dollars spent in the United States is related to health care. Doctors, hospitals, insurance companies, the elderly, the poor, the unemployed, small businesses, large corporations--almost everyone, in one way or other, will be affected. A health-care law will be as important as any piece of social-reform legislation in the country's history--as consequential as the Social Security, Medicare or civil-rights law enacted in the 204 years of the Republic.
Much more than health-care reform is at stake here; the coming debate will raise a question that has troubled Americans since the founding of the nation: What is the proper role of government in shaping our everyday lives? The Clinton proposal to revamp the American way of health, to be officially unveiled on Wednesday, will test anew our faith in government to meet an economic and social challenge as great as any we have confronted since the Great Depression of the 1930s.
The current climate of opinion about government effectiveness considerably lengthens the odds of getting a major health-care law enacted soon. We are in one of our periodic funks about the ability of public officials to do anything right. As throughout so much of our history, we harbor profound doubts about the wisdom of letting government leaders shape our private actions. At the same time, we have unbreakable attachments to the many government programs that have improved the lives of all Americans in the last hundred years.
We suffer from a kind of national schizophrenia. Our history is partly the story of wide mood swings about the defects and virtues of government. In one decade, we see public officials and their use of almost any authority as an insult to the national self-esteem, and in the next, we celebrate the heroic efforts of public servants serving the national well-being.
Antagonism to government is as old as the republic itself. "The government that governs least, governs best," Thomas Jefferson told us. And most of his successors echoed his conviction. Laissez-faire was part of the original American credo. Tampering with individual rights, regulating anyone's freedom of choice, provoked memories of British rule and the tyrannies of Old World Europe, from which most of the country's inhabitants had fled.
At the same time, though, abolitionists, Populists and Progressives effectively advanced the case for federal authority as the moral conscience of the nation. They pushed local, state and federal officials into addressing the economic dislocations and social injustices that beset the country throughout the 19th Century and first years of the 20th.
Conservatives also continued to have their day. The 1870s, '80s, and 1920s were notable for passive, corrupt governments at all levels. The prevailing sentiment of these decades was captured in Calvin Coolidge's observation, "The business of America is business." But Herbert Hoover's failure to overcome the economic collapse that began in 1929 gave laissez-faire a bad name.
The Great Depression created the modern belief in the need for a compassionate federal government devoted to the solution of national problems. Franklin D. Roosevelt expressed the public mood when he declared in June, 1936, "Governments can err, Presidents do make mistakes, but the immortal Dante tells us that divine justice weighs the sins of the cold-blooded and the sins of the warm-hearted in different scales. Better the occasional faults of a government that lives in a spirit of charity than the constant omission of a government frozen in the ice of its own indifference."
By 1968, after a post-Roosevelt reaction against government activism in the 1950s and another powerful burst of reformism in the '60s, the country fell into a new mood of anti-government sentiment that has lasted 25 years. The failure in Vietnam, Lyndon B. Johnson's credibility gap, Richard Nixon's Watergate transgressions, Ronald Reagan's Iran-Contra affair, and the scandals associated with Koreagate, former House Speaker Jim Wright, BCCI and the House banking and post office all created the sense that government exists not for the well-being of the many but the advantage of the few.
Affirmative-action programs seeking to right historic injustices have added to the sense that government--liberal, activist, intrusive government--functions less for the good of all citizens than as the captive of complainants against the country's industrious, white middle-class tax-payers unfairly blamed for ancient abuses they had nothing to do with. At least, this is how many of the conservative supporters of Reagan, George Bush and, now, Ross Perot see it.
Add to this the feeling that Johnson's Great Society programs and War on Poverty in the 1960s failed to deliver on a promised end to human misery and the realization of unprecedented prosperity and harmony, and you see one more reason why government has less than a secure hold on the national imagination.
In the 1980s, when President Reagan repeatedly said, "Government is not the solution, government is the problem" he was reinforcing a winning political issue. When Bill Clinton and Al Gore declared their determination to eliminate government waste, they also understood they were attacking something everyone in America loves to hate. Recent opinion polls asking people to assess Congress and the President reveal an appalling lack of trust in both the legislative and executive branches. Nearly two-thirds of Americans don't believe the government will do what is right for the country.
The great challenge for Clinton and advocates of health-care reform is nothing less than the need to recreate a belief in the capacity of government to apply reasoned intelligence to an outsized national problem. Surely, there will be no substitute for sensible, realistic proposals in convincing the country that the Clinton health-reform act deserves a chance to prove itself. But the problem is so large, the issue so complex, that whatever the White House proposes, it will inevitably fall short of convincing a majority of Americans that a solution is at hand.
Selling any reform plan to the nation will require an act of faith. It will partly depend on reminding the country that national regulation of business, labor, the environment, social relations, economic growth, war and peace has partly been a great success story. Theodore Roosevelt's conservation measures; Woodrow Wilson's Federal Reserve system; Franklin Roosevelt's Tennessee Valley Authority, Security and Exchange Commission, Social Security System and minimum wages and maximum hours under the Fair Labor Standards Act; John F. Kennedy's commitment to land a man on the moon and ban nuclear testing in the atmosphere; Johnson's Civil Rights and Voting Rights acts, Medicare and Medicaid, Federal Aid to Elementary, Secondary and Higher Education and Head Start are just some of the more prominent of the great economic and social advances engineered by the federal government in this century.
There is something more here the Clinton White House might want to remember. If history is any guide, winning a fight for health-care reform will serve the national well-being in other ways. Every great progressive advance sponsored by the government in the last hundred years has generated a renewed sense of national purpose, a belief in the fundamental decency of the nation. A compassionate health-care program that extends coverage to the less fortunate among us and restrains the growth of costs that threaten to cripple our economic system will restore a badly needed measure of pride in what the Founding Fathers saw as a system of government that was the last best hope of mankind.*