Imbalance of Power Defines Struggle Over Health Care : Clinton needs help of broad-based movements like labor, civil rights to counter conservative gains.

If Jimmy Carter had passed labor law reform in 1978, Bill Clinton might have a better chance of passing health care reform in 1994.

Not many in the Clinton Administration understand that connection, or its implication for their agenda. But if Carter had broken the conservative filibuster that blocked labor law reform 16 years ago last month, the union movement would represent a larger share of the work force today. With more workers, the unions would have more clout to invest in the fight for Clinton’s health care reform when it faces the inevitable conservative filibuster later this year in Congress.

“If you had, for instance, a labor movement representing 30% to 35% of the (private sector) labor force instead of 12%, that kind of base would be a much more potent force in the health care debate, as well as so many other things the Administration wants to do,” said one ranking Administration official sympathetic to this viewpoint.

As both candidate and President, Clinton has rightly sought to demonstrate his independence from labor and other Democratic constituency groups. But those well-publicized disputes with labor over the North American Free Trade Agreement, or with civil rights organizations over the proposed Racial Justice Act, obscure a larger truth. On most issues, especially bread-and-butter economic concerns, those groups push in the same direction as a Democratic President. On Capitol Hill, he needs them as a counterweight to business and the ideological lobbies hostile to activist government.

The left’s weakness leaves Clinton in an exposed position. On almost all issues--from health care to domestic spending--Clinton has been first over the hill, leading the charge for government to take on new responsibilities. But it reverses the pattern of history for the President to take the point. In previous eras of government activism, the driving force has been not the President but broad-based social movements whose insistent demands forced Washington to respond.

Today there’s nothing comparable to the progressive and Populist movements at the turn of the century that furrowed the ground for the pure food and drug acts and the progressive income tax; the incipient labor movement and share-the-wealth grass-roots uprisings led by Huey P. Long and Francis V. Townsend that helped inspire the Social Security Act in 1935, or the civil rights and consumer movements that powered through the anti-discrimination and environmental laws that cascaded out of Congress from 1964 through 1972.

“The question after Clinton’s election was what kind of new force was going to emerge to push the elected officials and the President, and that hasn’t happened at any level,” one union official says. “The right is on the ascendancy, the business community is on the ascendancy, but the progressive community is not.”

That imbalance has defined the lobbying struggle over health care. So far the decisive thrusts have been the health insurance industry’s “Harry and Louise” TV ads and the National Federation of Independent Business’ ferocious mobilization against employer mandates.

On paper, the forces behind universal health care coverage are formidable: the 47 organizations allied in the Health Care Reform Project, an umbrella lobbying group that claims 65 million members. Last week, the AFL-CIO, the American Assn. of Retired Persons and the American Medical Assn. joined for a new push behind universal insurance coverage. But they have a lot of ground to make up.

As in any faltering campaign, that’s provoked a lot of finger-pointing. The groups blame the White House for an unsteady legislative and communication strategy; some labor officials insist it’s difficult to motivate the rank-and-file behind a President who crossed them on NAFTA and didn’t exert much energy when the anti-strikebreaker bill quietly died earlier this month in the Senate. The White House, and many reform proponents on Capitol Hill, slap the groups for focusing too much on their own parochial interests and not enough on generating support for an overall package.

That narrowness of vision points to the left’s larger problem. Since the early 1970s, the left’s capacity to mobilize a mass movement has withered; today, civil rights groups, consumer organizations and organized labor function more as Washington pressure groups than as true conduits to the grass roots. They’ve become more adept at finessing the regulatory process and filing lawsuits than reaching a broad public audience. “What’s happened to these interest groups is what happened to academics: They started to speak only to themselves,” one senior White House official says.

Those groups won’t fully solve their problems until they rethink their methods and agendas. But some in the Administration hope the imbalance in the health care fight prompts Clinton to think about what government can do to help renew the groups aligned with Democrats.

Franklin D. Roosevelt offers the most successful precedent in this century for that kind of strategic thinking: By signing the National Labor Relations Act that established workers’ right to collective bargaining, he jump-started the labor movement, which then anchored the Democratic majority for the next 30 years. Ronald Reagan displayed a similar sense by irrigating Republican territories in the South and West with rivers of defense spending.

There’s not as much Clinton can do to directly bolster Democratic-leaning groups like consumer organizations or civil rights groups. At most, says one White House official, reform of voter registration and campaign finance laws can indirectly boost such groups by diminishing the influence of money in elections, and increasing the importance of grass-roots organizing.

For those Democrats interested in an institution-building strategy, the real question is whether Clinton can (or should) try to resuscitate labor. There are many reasons for labor’s long slide over the past 40 years, including its own internal ossification, but one key factor has been the inability of the labor laws to guarantee a fair fight in organizing campaigns: Since the early 1950s, the number of unfair labor practice charges annually filed against employers has increased sixfold, while the percentage of union victories in certification elections has dropped from about 70% to just under 50%.

Later this year, an Administration-appointed commission led by former Labor Secretary John T. Dunlop is expected to propose labor law reforms that would toughen enforcement against businesses that use illegal practices--such as firing workers--to discourage organizing. Those recommendations will force Clinton to confront the basic issue: Would Democrats and the average Americans they aim to represent be better off with a stronger labor movement?

Former Democratic presidential candidates Hubert H. Humphrey or Walter F. Mondale would have answered that question without hesitation. But some around Clinton are uncertain of organized labor’s place in a “New Democrat” Party, or for that matter a new workplace of flexible production and joint worker-management committees.

Labor, civil rights and consumer groups harbor comparable doubts about whether Clinton is the best the left can hope for in the Oval Office. Each side in this argument has legitimate grievances with the other. But the lopsided fight over health care suggests that in a fundamentally conservative climate, the first priority for Clinton and the Democratic base should be finding ways to more effectively bolster each other.

The Washington Outlook column appears in this space every other Monday.

Activism’s Hall of Fame

During the three previous periods of government activism in this century--the Progressive Era in the 1990s and the 1910s, the New Deal in the ‘30s and the Great Society in the 1960s--pressure for Washington to take on new responsibilities came from broad-based social movements.

THREE LEADERS IN THOSE MOVEMENTS

William Jennings Bryan: The eloquent Nebraska populist who ran three times for President as a Democrat around the turn of the century.

John L. Lewis: Founder of the Congress of Industrial Organizations and the nation’s most-powerful labor leader in the Depression.

Martin Luther King Jr.: Led the civil rights movement that inspired the Civil Rights and Voting Rights acts of the mid-1960s.