A Doubly Daring Venture : Clinton aims at both health care and welfare

“I know it will be difficult to tackle welfare reform in 1994 at the same time we tackle health care. But let me point out I think it is inevitable and imperative.”

With that, in his State of the Union address Tuesday evening, President Clinton signaled a willingness to pursue simultaneously perhaps the two toughest and most complex domestic problems this nation faces.

It’s smart politics in pursuit of good public policy--but indisputably a tricky and complex proposition.

Practically speaking, if he does not embrace welfare reform at the same time, Clinton is likely to face defeat on his major initiative to provide basic health care coverage to all.

Indeed, Sen. Daniel Patrick Moynihan, chairman of the Finance Committee, let it be known before the President’s address that he felt that the need to reform the welfare system was more pressing than health care. The New York Democrat even suggested he might sideline health care bills in his committee if welfare reform was not given the same priority.

But politics aside, tackling health care and welfare simultaneously can be a win-win proposition for Clinton if he does it right. Though each issue is uniquely complex, the social and economic impacts of our hobbled welfare and health care systems inextricably bind the two issues.

An estimated 1 million people are on welfare today because that is the only way they can get health care for their children. If they leave welfare for entry-level or part-time jobs, in many cases they are without coverage. Millions of working Americans who have no health care coverage often must resort to expensive emergency services when they become sick or injured. The costs of that are passed on to people fortunate enough to have health insurance, in the form of higher premiums or reduced coverage.

Health care reform cuts across all classes. Though recent attention has focused on a slowing in the rise of health care costs, total U.S. health care spending in 1993 was $942.5 billion, up $102.1 billion from the year before--the biggest one-year dollar increase ever.

The number of Americans without health insurance has risen as well, to 38.9 million in 1992 from 36.6 million the year before. So the need for reform that provides universal coverage is as pressing as ever.

In Tuesday’s address the President said, “We’ve got to solve the health care problem to have real welfare reform.” He’s right. And by taking on both of them at once, he has shown clearly that his State of the Union speech was intended to be far more than rhetoric.