‘Crisis? What Crisis?’--The GOP Responds to the Health-Care Issue : Politics: Republicans will admit there are some ‘problems’ but insist the Democrats are overstating the case. The polls show something else.

On Tuesday night, President Bill Clinton renewed his effort to redeem the most important promise he made to the people who elected him: to reform the country’s health- care system so it provides universal and affordable coverage. Back on Election Day, 1992, Clinton voters named health care their top priority after fixing the economy. A year later, polls show health-care reform is the Clinton campaign promise that has most stayed in the minds of the public.

Throughout the past year, Republicans have regularly voiced anger at Clinton’s failing to make good on one 1992 promise or another. Now we know how they feel when he tries to make good on a key pledge: They really get upset.

Health care has put Republicans on the defensive, because they have no track record--and thus little credibility with the voters--on the issue. Their struggle for a response has led to some bruising intrafamily fights. But now they have forged a rough consensus--made up of one part narrow partisanship and two parts ideological rigidity, with a generous dusting of cynicism.

The Republican rejoinder--you may wonder why this took so long--is: “Crisis? What crisis?” America has health-care “serious problems,” says Senate Minority Leader Bob Dole of Kansas, not a health-care “crisis.” As its first line of defense, then, the party has revived its Vietnam strategy: Declare victory and go home.

They usually base the no-crisis claim on poll results that show a large majority of Americans satisfied with their own health care. These figures are accurate--and beside the point. No one has suggested that the crisis is one of quality. It is a crisis of two other serious and interrelated factors: cost and coverage. Every poll on the issue shows the public somewhere between disgruntled and angry about the former, and somewhere between nervous and frightened regarding the latter.

The facts bear out both anxieties. Americans today pay half again as much for health care, measured as a percentage of their family income, compared with 1980. By the end of the decade, they will pay twice as much. People are being hit harder at every stage--the cost of services, the share of premiums employers require them to pay and deductibles.

Health-care inflation, while easing this year, also remains a tremendously serious problem for the larger economy. Businesses have been hit hard, seeing their health-care tab triple since 1980. Small businesses--those that take the responsible course and insure their employees--have it toughest of all.

The struggle over who will pay the costs frequently poisons labor-management relations, provoking many of the most significant strikes in recent years. Rising health-care costs have been a crushing burden on local, state and federal government--accounting for virtually all the increase in government spending since 1980. If the United States had a normal level of health-care expenditures, we would literally not have a deficit problem!

On the insurance-coverage issue, Republicans argue that the much-cited 37 million uninsured figure is a snapshot at any one time, and that most of them are not permanently uninsured. That’s right, which is why 37 million understates the extent of coverage insecurity.

Census figures show that nearly twice as many Americans--about one-quarter of the population--can expect to lose coverage in a two-year period. And the vast majority of them will remain uninsured for four months or longer--hardly a trivial duration. In addition, millions more families face the reality or real possibility of losing insurance because they become injured or seriously ill, thanks to the notorious “pre-existing condition” policies of most insurers.

Of course, Republicans point out that most people who experience periods of non-coverage don’t have the misfortune to get seriously ill in that time. And most will not develop a chronic condition bad enough to deny them coverage. Well, yes, but millions do--and that’s a disgrace.

One could use the same logic, more plausibly in fact, to argue there is no crime crisis: Well over 90% will not be a victim of crime this year, and most are not even at any real risk. You can imagine the indignant GOP response to such a notion.

Moreover, this whole line of reasoning ignores the essential nature of insurance. We pay a lot for insurance, but hope never to use it--it’s not a normal economic good. Its value is to be there when we need it, and relieve insecurity the rest of the time. America’s bizarre patchwork private insurance system--using system loosely here--doesn’t meet this basic standard. Maybe if private insurers started issuing home-owner policies that covered expensive artwork and jewelry--except in cases where someone broke into your home and stole it--the GOP would take decisive leadership in the fight for insurance reform.

The public understands social insurance, but Republican leaders never seem to have quite grasped the concept--from the introduction of Social Security, to Medicare, to today. Once it happens and is politically popular, they sign on, but each time is met at the time with the cry of “socialism.” Academic-turned-Sen. Phil Gramm of Texas carries this old and tattered flag into battle even now with no apparent sense of irony--perhaps because he was trained as an economist, not an historian.

The problems of cost and coverage leave the public with no real doubt about whether their health-care system is in crisis. In recent polling by NBC and the Wall Street Journal, 78% say the system does not meet the needs of most Americans; as a concern and priority, it ranks with crime at the top of the list, far ahead of welfare reform. And people are prepared for--in fact, demand--fairly radical surgery: Seven in 10 say more government involvement is acceptable, and a “complete overhaul” is required.

Republicans assert that the public is mistaken about all this, taken in, perhaps, by Hillary Rodham Clinton. Besides being wrong on the substance, this rejoinder has the additional shortcoming--as Rep. Newt Gingrich (R-Ga) warns his brethren--of political foolishness. It signals to the public that the complacent Republican Party of George Bush lives on, and won’t step up to the big issues.

“Small solutions for small problems” is today’s Republican watchword, and Democrats could hardly wish for a better opposition. If the GOP keeps getting it wrong on health care--the way they consistently said the economy was not a problem in 1992--it could soon be a party in crisis.