Orange County Voices : COMMENTARY ON HEALTH CARE : Congress and the People Should See the Final Bill Before a Vote : We don’t let doctors operate blindfolded. Such sweeping legislation shouldn’t be made law with a rubber-stamp.

The stakes in the national health-care debate could hardly be higher: this is, quite literally, a matter of life and death for every American. And the economic impact of health care reform is equally fundamental to the American economy. The Congressional Budget Office estimates that this year, medical services will total $982 billion--fully one-seventh of our Gross Domestic Product.

Not surprisingly, redesigning the entire health-care system is dauntingly complex. The Clinton plan, for example, takes 1,364 pages to cover the topic. That’s longer than the Bible, or “War and Peace,” or the Los Angeles telephone directory.

Given both the complexity and the gravity of health-care reform, it should follow that the final legislative product, if there is one this year, will be the most carefully scrutinized document since the Magna Carta.

But in fact, the opposite is true. Welcome to the modern Congress.

As the debate over health care has unfolded, we have begun to see what is quickly becoming an iron law of politically important legislation: that there is an inverse relationship between the care taken in writing and scrutinizing a bill, on the one hand, and its importance, on the other.

The Clinton plan, like the handful of other health-care proposals introduced earlier this year--that is, the ones that are going to get radically changed--took a long time to write and was exhaustively studied and criticized.

But now that the Congress is moving closer and closer to adjournment, the care taken in writing and reading each successive proposal is precipitously declining. By the end it is entirely possible that Congress will vote on a measure that none of its members, or their staffs, or the executive branch, or the public has had any opportunity to consider.

This sorry state of affairs arises in part by accident and in part by design. Stealth lawmaking benefits the handful of key legislators and lobbyists who are steering negotiations and drafting. And it marginalizes the rest of Congress, not to mention the outside world, making it possible for political “leaders” to deliver on a promise to get “something” done.

Some of those supposed leaders think the only way to pass a health care bill is to keep the American people in the dark. One of President Clinton’s chief lieutenants in the Congress. Sen . John D. (Jay) Rockefeller IV (D-W.Va.), recently said: “We’re going to push through health care--regardless of the views of the American people.”

But the fundamental problem is that Congress is simply not well organized to tackle wide-ranging, interdisciplinary subjects.

A topic like health care, embracing a seventh of the economy, is of interest to any committee that can plausibly claim jurisdiction over any part of it. Right now, four committees of the House and Senate are working, basically without any coordination, on five comprehensive health-care bills.

As the clock ticks down toward the October adjournment of Congress, the three disjointed House bills ultimately reported out of committee will be utterly rewritten into one brand new bill in the closed-door Democratic Caucus.

In the Senate, staffers for Sens. (Edward M.) Kennedy (D-Mass.) and (Daniel Patrick) Moynihan (D-N.Y.) will join assorted lobbyists in a similar frenzy of last-minute drafting. The resulting spectacle will more closely resemble Civil War battlefield surgery than a rational attempt to make public policy.

If recent history is any guide, Congress and the public will have minimal time to review these legislative Frankensteins. Even if Congress, the press and the public can somehow read the final House and Senate bills, it won’t much matter. The House-Senate conference rules permit throwing out any or all of them, and substituting novel provisions that neither house has ever seen or voted on.

The ensuing breakneck dash to “pass health care” before adjournment (and the November election) will find the conferees (in reality, a select group of lobbyists and staffers) frantically drafting an eleventh-hour, immense, possibly illegible, often handwritten collection of hundreds of loose-leaf pages.

It is entirely likely, therefore, that members of Congress will never even see what they are voting on, and that no one--not the staffers, the conferees, the interest groups, not even Hillary Rodham Clinton--will have any idea of its details until afterward.

It follows, of course, that no one will have any idea of the bill’s costs until it is too late. It takes the Congressional Budget Office four to five weeks to produce its (often quite inaccurate) cost estimates. CBO has already warned Congress that the process of writing health-care legislation should be “much, much slower” if we want reliable figures.

Yet even now, congressional committees are voting on newly-minted proposals without any reliable estimates of their costs. By adjournment, it is unlikely that there will be even back-of-the-envelope guesses about the costs of the final bill.

This is not a remote possibility or worst-case scenario. It has happened repeatedly in the last few years. The 776-page savings and loan bailout legislation--a tragically flawed bill which to date has cost taxpayers more than $100 billion--was not even printed until three days after Congress voted for it in the wee hours of a Saturday morning.

Likewise, the recent $151-billion, six-year transportation bill was passed by Congress before any copies of the actual bill had been printed or distributed for review. (The House voted at 6 a.m., only 65 minutes after the one and only typewritten copy of the 1,000-page bill arrived in the House chamber.) No senator or representative read it, either.

We are headed for a similar meltdown of the legislative process with a health-care bill.

It is a disturbing fact that the modern Congress regularly generates thousand-page epics whose most important features are neither read nor debated by the enacting lawmakers or the public.

But neither the President, nor the Congress, nor the American people should be asked to rubber-stamp such a sweeping act as the redesign of the entire American health-care system, immediately after it has been concocted in a legislative version of blind man’s buff.

To ensure that this doesn’t happen, each of us, whatever our preferred reform, should insist that any health-care bill be made publicly available 30 days in advance of a final vote, so that we can read and understand it. Anything less is unacceptable.

We don’t let doctors operate blindfolded. We should make sure Congress and the public aren’t blindfolded as we make the key decisions on health-care reform.