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Health-Care Shifts

IF there is one issue that Bill Clinton feels compelled to move ahead on quickly next year, it's health-care reform. He promised universal health-insurance coverage at nearly every campaign stop.

Few in Washington would deny that reducing the inequities in the current system and halting its runaway cost are social and fiscal necessities. But no one in government would say it's going to be easy.

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While the new president may get some initial proposals underway during his first 100 days, as promised, he's not likely to get comprehensive reforms through Congress on anything like that schedule. Nor should he. The debate is too complex, and the political hurdles, posed by interest groups with a stake in health care, are too high.

Some of those hurdles have been lowered in the last few months, however. Back in September, a large medical specialty group, the American College of Physicians, endorsed an overall limit on national health-care spending. This month the Health Insurance Association of America backed federally mandated universal coverage.

The association's members, especially the smaller firms, acted out of clear self-interest: The move toward a national plan appears irreversible, and they didn't want to be left in the dust.

Whatever its motives, the insurance industry's decision to get behind the Clinton push - instead of in its way - increases the political momentum. Among other proposals, the association suggested curtailing the tax-free status of some health-care benefits. Only a basic package of benefits would remain tax free. That idea had been thought to be politically impossible. But the same was once true of any tax on Social Security benefits. That changed, and so will this.

Efficiency, fairness, and freedom of choice all need to be woven into a new health-care system. The flexibility represented in the insurers' changed stance can help the country move toward that goal.

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