The Lessons From a Stalled Reform : A true health care consensus is missing

Whenever a President suffers a political blow of the proportion President Clinton suffered in his apparent failure to get comprehensive health care reform this year, the post-mortems abound: What should Clinton have done different? What are the lessons?

Clinton has now noted what many others already had--that because one-seventh of the U.S. economy is involved, health reform should be done deliberately and incrementally. Once the Administration’s own proposal was clearly dead, a 1,400-plus-page Democratic plan aimed to eventually provide insurance for all Americans. But while the plan contained new benefits for those already insured (for example, the popular proposal to pay for Medicare prescription drugs), it did not do much to bring in the 37 million Americans who have no coverage at all. The bill was full of mixed signals, in part because mixed signals were what Washington got from the people.

Those signals were typified by one person who told a reporter that she hoped that health care reform did not mean that the government would get involved with Medicare--as if unaware that Medicare is indeed a government entitlement program.

What could Clinton have done to better ride the shifting political winds on health care reform, so strongly in his favor two years ago? One, he and First Lady Hillary Rodham Clinton could have recognized that the findings of the Administration’s early health care reform task force would not be embraced if exclusive meetings were held in secretive sessions. Bad idea. Next, the Administration might have learned more from the last time Washington--led by a Republican administration in 1974--tried to tackle health care reform.

Some similarities are eerie: Then-President Richard Nixon called national health insurance his top domestic priority. Despite the Nixon Administration being weakened by the mushrooming Watergate scandal, then-Health, Education and Welfare Secretary Caspar W. Weinberger called for “adding, this year, comprehensive health insurance protection to the basic security guarantees that America offers.”

Republicans were ready to compromise; Democrats, anticipating gains in the November election, held out for a better deal, while medical, labor and business lobbyists swarmed in the background. Switch parties, move the clock up 20 years and it all sounds depressingly familiar.

History really doesn’t have to repeat itself. But in order to avoid that seemingly natural cycle, America’s leaders--and its people--must be clear not only on what they are trying to accomplish but on what they are willing to do to achieve it. A national consensus on what’s needed to fix health care, the prerequisite to major social reform, is unfortunately missing.