Why Health-Care Reform May Be Beyond Saving

William Schneider, a contributing editor to Opinion, is a political analyst for CNN

Comprehensive health-care reform is in big trouble. Here's the reason: President Bill Clinton has lost the support of a crucial political ally--the middle class.

Without the support of the middle class, the odds are against the President on health care. Those odds worsened considerably last week with Clinton's stunning defeat in the House of Representatives on the crime bill.

Members of Congress weren't afraid of the President. They figured there was no price to pay for defying him. Imagine what would have happened to a congressman who crossed Lyndon B. Johnson or Ronald Reagan on a vote like that.

In politics, where there's no fear, there's no clout. If the President couldn't get members to cast an easy vote on a popular measure like the crime bill, imagine how hard it will be to get them to cast a tough vote on health-care reform.

That wasn't the way it was supposed to be. Clinton got elected President as the champion of "people who work hard and play by the rules." That's what being a "New Democrat" means. The "Old Democrats" were the ones who wanted to tax the middle class to pay for social-welfare programs for the poor.

Now look at what's happened. A CNN-USA Today-Gallup poll taken last week asked people who they thought would benefit most from health-care reform: "upper-class Americans, the middle class, the poor, or everyone about equally"? Answer: the poor. Who did people think would be hurt most by reform? Answer: the middle class.

Now, this is strange, because what created the health-care issue in the first place was middle-class panic. The recession of 1990-91 had a devastating impact on white-collar employment. It created a terrifying prospect for middle-class workers who had no unions to protect them. Losing their jobs meant losing their health insurance--and their families' health insurance. To make matters worse, health-care costs were rising out of sight. Individual health insurance was unaffordable. Medical problems carried the threat of impoverishment.

It was Harris Wofford who showed Democrats the way in November, 1991. He asked a devastating question: If every criminal has a right to a lawyer, shouldn't every American citizen have a right to a doctor? With that, Wofford trounced the Bush Administration's stand-in candidate, former Atty. Gen. Dick Thornburgh, in the Pennsylvania U.S. Senate election.

Clinton took up the health-care issue and rode it all the way to the White House. He even figured out how to make sure the issue appealed to the middle class. Clinton insisted throughout on "universal coverage." Universal means available to everybody; in other words, not means-tested. If a program is means-tested, the benefits go to the people who need them the most, i.e., the poor. And the middle class pays the bill. That's Old Democratic thinking.

The definition of the middle class in this country is simple: neither rich nor poor. Middle-class people know there are people poorer than themselves. They know government programs based on "need" will help poor people, because their needs are the greatest. Government programs like Social Security and Medicare are not based on need. That's why they are politically sacrosanct. They help everyone, whether they need it or not. That's why such "entitlement" programs are so expensive: You have to bribe the middle class to support programs that only incidentally help the poor.

Clinton deliberately modeled his health-care plan after Social Security. Remember the health security card he held up in his State of the Union speech last January? It looked just like a Social Security card. It was supposed to. Clinton figured that his dogged insistence on universal coverage was the key to winning the middle class.

Democrats played to the middle-class fear of losing health insurance. In introducing his bill Tuesday, Senate Majority Leader George J. Mitchell (D-Me.) called it a matter of "simple justice." He said, "The difference between secure coverage and unaffordable policy can be as heartbreaking as one sick child. That's not fair or right. That's why we need reform."

But Republicans discovered another middle-class concern--that the federal government will have too much control over the nation's health-care system. Senate Minority Leader Bob Dole (R-Kan.) said the "Clinton-Mitchell bill" was based on "the principle that government knows best." If the bill passed, Dole warned, "the federal government will have broad and sweeping new powers in almost every aspect of health care."

Last week's poll tested those two fears. Which concerns Americans the most--that Congress will pass a plan that gives the federal government too much control over health care, or that Congress will pass a plan that fails to guarantee health insurance for every American?

Bad news for Clinton. Too much government was a bigger concern than too little health insurance, by 53%-40%.

The public now sees comprehensive health-care reform as a typical Democratic social-welfare program--one that helps the poor, hurts the middle class and creates bigger government.

What went wrong? Three things.

First, the recession ended. The recovery hasn't been strong enough for anyone to call it a Clinton boom. But it has been strong enough for the middle-class panic over health care to subside. That, plus the fact that health-care providers, fearful of reform, have begun to reorganize themselves. As a result, the rapid inflation of health care has slowed considerably.

Second, the Clinton Administration displayed awesome political stupidity. It turned health-care reform over to a 500-person task force of self-anointed experts, meeting for months in secret, chaired by a sinister liberal activist and a driven First Lady. Who elected them? They came up with a 1,300-page document that could not have been better designed to scare the wits out of Americans. It was the living embodiment of Big Government--or Big Brother.

"What's in there?" people asked. The Health Insurance Assn. of America introduced Harry and Louise to give us the answer.

Now, of course, the Clinton plan has been abandoned. As it happens, the new and improved plan designed by Mitchell is 1,410 pages long. It makes quite a prop in the Senate floor debate. Watch Republican senators pick it up--oof!--and wave it at the cameras.

Third, the Administration made a serious miscalculation. It assumed it could sell health-care reform to the middle class as the logical extension of Social Security and Medicare--"the last unfinished business of the New Deal."

Opponents of health-care reform, Mitchell said Tuesday, "will find themselves on the wrong side of history, just as the opponents of Social Security did, just as the opponents of Medicare did. . . . Americans couldn't be persuaded to repeal Social Security and Medicare by the same arguments now being made against health-care reform."

"I think you in the press ought to go up and question some of these people about what their position is on Medicare," Hillary Rodham Clinton said in an interview with reporters, "and whether or not they believe mandatory payroll deductions to finance health care for Americans over 65 is socialized medicine. Because of course it isn't."

But the analogy doesn't hold. For one thing, the biggest single change in American political attitudes since the 1960s has been the collapse of confidence in government. In the 1930s, when Social Security was passed, desperate Americans believed the federal government could save them. It did. In the 1960s, when Medicare and civil rights were passed, old people and black people believed the federal government could protect them. It did. But in the 1990s, Americans are not so sure about either of these things. Middle-class Americans are no longer convinced that the federal government is on their side.

There's another reason why the analogy doesn't hold. When Social Security came up in the 1930s, most people didn't have old-age insurance. Pension plans were meager or nonexistent. Most of the elderly had to rely on the tender mercies of their relatives. Social Security gave them something they didn't have.

When Medicare came up in the 1960s, most old people didn't have adequate health insurance. Americans get their health insurance through employment, after all, and the vast majority of the elderly are not employed. The elderly, who have the greatest need for health care, faced prohibitive costs. Medicare gave them something they didn't have.

But the vast majority of middle-class Americans today do have health insurance. And they say they are satisfied with both the quality of their health care and the quality of their health insurance. So what are they worried about? Well, they're worried about losing their health insurance if they lose their job. And they're worried about being able to afford it if the rates go up. Those are the problems they want health-care reform to fix. They are limited, specific problems.

They see the Administration's health-care plan as doing far more than that. It aims to reorganize the whole health-care system so that the government will give them something they already have , namely, health insurance.

People's biggest fear about the Administration's health-care plan is that it will take what they already have and make it worse. Members of Congress report that they have been getting more calls and letters from constituents who ask, "What's going to happen to me if this bill passes?" than from people who ask, "What's going to happen to me if this bill doesn't pass?"

Last week's poll puts that issue to the test. "Thinking about just your own health-care situation," the poll asked, "which worries you more--that you could end up without health insurance if Congress doesn't pass a bill, or that you could end up worse off than you are now if Congress does pass a bill?" By a solid margin, 54%-30%, people are more worried about what will happen to them if health-care reform passes.

That's exactly why the President's plan is in serious trouble. The Administration assumes that middle-class people are driven by the fear of not getting the additional security they want. But there is another, much larger fear driving them. That is the fear of losing the security they already have.*

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