A Big Push--or a Big Flop : NAFTA-caliber effort is needed for health care

Though national health care reform is beginning to receive a full hearing in Congress, just what it all means remains vague in the minds of many Americans. That’s why the battle for reform must be waged in the nation’s heartlands as well as on Capitol Hill. So far the opponents of reform have managed to define it as something to be feared, as if all the affable Dr. Marcus Welbys of America stand to be rounded up, thrown in a gulag and replaced by automaton clock-punchers in white coats. The new television ads for President Clinton’s reform plan are a start, but by no means are they enough. The President will need to do more. Before long the Administration may need to parallel the impressive, successful effort that it carried out on behalf of the North American Free Trade Agreement.

NOT EASY TO SELL SO MUCH COMPLEXITY: And before the Capitol Hill lobbying effort goes full throttle, voter-constituents must be persuaded that the status quo in the health care system is not acceptable; that it’s only a matter of time before they or someone they love will free-fall into one of the system’s many holes. If there is fear and dread about the health care issue, Americans should be persuaded to also fear and dread the thought that they might be left out of the existing system; they must not be led by the enemies of reform to draw back from the complexities and difficulties of achieving reform. For without major reform, health insurance will continue to be unattainable for millions, people who thus will be denied everything but emergency care.

It doesn’t help that health care reform is stuck with bureaucratic jargon like providers (that means hospitals, doctors and others that provide care) and health alliances (the purchasing groups that would provide leverage for insurance buyers). But health care reform need not be intimidating or hopelessly complicated. Californians already know that, because they are far ahead in one key aspect of reform: managed care. An astonishing 75% of insured Californians, or about 18 million, belong to some form of managed care. The success of Kaiser Permanente and other forms of managed medical care in California has not caused this state to sink into the Pacific (at least not yet). Nor will thoughtful national health care reform lead to the end of Everything Good in medical care.

BUT SELL THEY MUST IF IT IS TO FLY: It’s the job of President Clinton, Hillary Rodham Clinton and health care reform advocates in Congress to come up with a plan that does not “fix” what is not broken. Thus the Clintons’ often-expressed willingness to be flexible is crucial; some major elements of the Clinton health care proposal are in trouble because they seem unnecessarily intrusive.

Despite all its troubles with Whitewater, the Clinton Administration had better find ways to end the fear of reform, and soon, or there will be no reform. As President Richard Nixon discovered when he tried to push for national health care changes in the early 1970s, the political moment, once passed, can be forever lost.