But Why Is It So Darn Complex? : Simplistic health care reform just can’t be done

Fools rush in where angels fear to tread. That wise and lovely old line comes to mind just about every time the subject of President Clinton’s health care reform comes to the surface--as it did Wednesday when the Administration dropped its long-awaited legislative package on Congress. All 1,342 pages of it.

The complexity was inevitable, as was the enormity. The two simplest options were either unavailable or impossible. One was to leave the current system alone and let it evolve willy-nilly. The other was to go off 180 degrees in the other direction and graft a large, European- or Canadian-style government-as-Big-Doctor system onto U.S. society.

The latter was politically unacceptable--it would have about as much chance of getting through Congress as a “Packwood for President” resolution. And as for the former, the question before the House and Senate is this: Does the current system provide what Americans want? Are we really happy with what we have now?

President Clinton’s answer is negative; his is the correct judgment and has been all along. Even if the existing system does offer the best health care in the world for those who can afford it, America pays too much for it. Even then, too many Americans are cut out of the system.

But how to make it better?

The President knows that the hugely complicated draft he sent to Congress will go through many permutations before anything becomes law. He’s not troubled by that. Already he has signaled his flexibility--almost anything is negotiable. And that’s not such a bad idea.

The reason is that the President’s approach embraces two principles for which there is considerable public support. One is that more people should be brought into a system of more or less comprehensive coverage not only for reasons of social justice but for reasons of public health: 37 million Americans without health care coverage constitute a health menace not only to themselves but to others in the community. It’s just not a healthy situation.

Neither is the current system one of robust fiscal health. Price-is-no-object health care may be fine for the sultan of Brunei, or of Beverly Hills; but most Americans must live within a strict budget, and health care costs are rising faster than any other single category of national expense.

This is the bedrock reality on which the Clinton reform is grounded. The President indicates that he is willing to negotiate on almost every issue except universality of coverage and cost control. If Clinton doesn’t lose sight of these guiding principles, his health care reform stands a chance of success. Indeed, it would deserve to succeed.