Making Sense of the Health-Care Debate : Reform: The promised land may be out there, but the vision is distorted by interests who do not want to make the journey.

In the second year of the debate on health-care reform initiated by President Clinton, are we any closer to resolving the dispute? Or is the possibility of resolution ebbing away as the interest groups, pundits and politicians find fault with every plan but their own?

The past week has not been kind to Clinton’s reform effort. His State of the Union address was meant to reinvigorate the campaign but had precisely the opposite fate. The President and his wife wooed the Business Roundtable but the captains of commerce backed the rival bill of Rep. Jim Cooper (D-Tenn.). News stories then noted a pattern: the rejection of the Clinton bill by the Chamber of Commerce even as a starting point of debate, and further opposition by the National Assn. of Manufacturers and, predictably, Ross Perot. (And on Tuesday, the Congressional Budget Office’s deficit analysis of the President’s plan further amplified criticism.)

What does all this mean? Have we had a year of reflection by all these business figures? Does their rejection of the President’s laboriously produced plan tell us something significant about where the President went wrong and where the nation should go instead? We think not.

The debate has degenerated into a mix of ideological name-calling and numbing techno-babble. According to the newest critics, the problems with the President’s plan are familiar--excessive, intrusive bureaucracy and unaffordable, unworkable demands on American business. This is what most business leaders would have claimed had the President called for universalizing Medicare or borrowing the Canadian model of national health insurance, so obviously the President got little benefit from trying to anticipate business’ ideological objections in his initial proposal or from courting their approval after the fact. Indeed, why should anyone familiar with 20th-Century U.S. history expect organized business to lay aside its anti-government rhetoric and embrace compulsory health insurance?

The Administration now finds itself on the defensive. Critics on every side have questioned the complexity of the President’s reform scheme. Sen. Daniel Patrick Moynihan (D.-N.Y.) appeared to doubt whether the nation really faces a medical-care crisis; Sen. Bob Dole (R-Kan.) caricatured the Clinton bill with his now-infamous chart of complexity. Business groups complain about new bureaucracies, with no mention of the crazy quilt of private health-insurance bureaucracy we now face.

What we are experiencing is mostly political theater, not policy analysis. The scene has shifted from technocratic seminars to commentators and political junkies. For example, an inexperienced writer on health care peddles 5,000 words of abuse on the Clinton plan to the New Republic; before a rebuttal can be printed, George Will, Dole and others have repeated the story’s misleading claims. We are surely at a new stage, but it has little to do with the vital question of how health-care reform would work in practice.

What this does resemble is the worst of American political campaigns, full of she said / he said charge and countercharge. We have a crisis that threatens our whole society; there is no crisis. The public wants medical care reform; the public insists on the status quo. For every reform effort, there is a reaction--discredit and derail. The media do not cheer this confusing process, but those who thrive on conflict certainly nurture it.

Real events like the endorsement of the Cooper bill by the Business Roundtable are immediately transmogrified by spin doctors. As the New Democrat from Tennessee basked in media exposure, Citizen Action, a public-interest group, hit Cooper with a release charging that he accepted $200,000 last year in campaign contributions from the health industry.

While it is not surprising that corporate chief executives would support a bill that preserves much of the status quo over more sweeping change, it is also no surprise that there were groups waiting to take a shot at Cooper. And it is least surprising that the media would want to make a big deal of all of this.

The tools of obfuscation and manipulation are now insidiously effective. With so much at stake, every interest hyperventilates. The very survival of the Health Insurance Assn. of America hinges on the outcome. As such, the trade group feels more than justified claiming in its “Harry and Louise” commercials that choice and quality in American medicine would be destroyed by new bureaucracies dressed up as “alliances.”

Not all is darkness, however. The Kaiser Family Foundation and the League of Women Voters are devoting millions of dollars to distributing what they seriously regard as the truth about U.S. medical problems and options. Their plain-spoken ads simply outline how many Americans lack health insurance and who they are.

But the most disturbing truth is that two years into one of the most important political debates in a generation, the most basic problems have not been sufficiently clarified for Americans to agree conclusively that our situation is critical and warrants substantial reform.

The Administration has brought us only so far. The promised land may be out there, but the reform vision is now clouded and distorted by interests that do not want to get there at all, or are hoping for a modest resettlement, not a wholesale exodus. Within Washington, the task may be deal-making. Outside Washington, the task is moral mobilization and clearer argument.