Timeout on Health Care
CONGRESS has returned from its July 4th recess to face one of the most sweeping pieces of legislative work since the New Deal: health-care reform.
The objective is to provide universal medical coverage while controlling the spiraling cost of medical care - in effect restructuring one-seventh of the United States economy. To meet these broad goals, lawmakers on Capitol Hill are struggling to distill out of four different plans one that will pass and that will avoid a presidential veto.
Congress should continue its work on this vital issue, but throw out the timetable to pass a bill by the Aug. 20 recess. Health-care reform is at once broad in scope and intimate in impact. Yet lawmakers in Washington have shifted the legislative machinery into overdrive. No time is being allowed to develop a broad public consensus on the specific plan that will result, let alone for senators and representatives to weigh it in its entirety against alternatives.
Not surprisingly, election-year politics is the effort's engine, as well as its incubator.
Thoughtful lawmakers on both sides of the aisle have been working on the topic for years. But it got a significant boost as a hot-button issue when Sen. Harris Wofford (D) of Pennsylvania used it to beat Republican Richard Thornburgh in the state's 1991 special Senate election. Democrats nationally sat up and took notice. They needed winning themes against President Bush, who still was riding high in the polls from the Gulf war but was seen as weak on domestic issues. The general theme of health-care reform capitalized on public satisfaction with the quality of care and anxiety about the cost and ``portability'' of coverage - particularly in times of high concerns about unemployment.
Today, many political analysts anticipate larger-than-usual losses for Democrats in Congress. To party leaders it's now or never for health-care reform - at least their version. But on a change of this magnitude on an issue this important, election calendars cannot be allowed to set artificial deadlines.
Much of the public remains vague, if not confused, about what lawmakers are crafting. A Times-Mirror survey released on Wednesday noted that while 76 percent of the respondents favor coverage of all medically necessary care, they neither rally strongly behind any specific reform proposal nor favor employer mandates.
The disapproval rating for President Clinton's plan has risen to around 50 percent in some polls. Voters are much more likely to reject lawmakers who oppose any reform than to reject lawmakers who support plans other than Mr. Clinton's.
Despite their best efforts, pollsters aren't helping. Voters are asked to rate Clinton's handling of ``the nation's health-care system'' when there isn't one for a president to manage.
Absent a sufficient public consensus, particularly given the public's general distrust of ``big government,'' Congress is in danger of moving in the wrong direction. Several of the plans contain provisions whose larger political and economic implications must be more thoroughly aired.
By laying out standard coverage levels in a national plan, health care in effect is being established as an entitlement or a civil right. Yet the political and economic implications of such a change have not yet been fully considered. Ironically, the move comes at a time when people seriously concerned about the federal budget deficit point to the growth of entitlement programs as one of the culprits.
In addition, the value of universal coverage is mistakenly being treated on an equal or superior footing with the larger societal value of universal choice. Traditional medical approaches are enshrined, despite the significant segment of Americans that seeks treatment outside the standard medical model. Christian healing through prayer, a vital element of the religious practice of Christian Scientists, is but one example. While reforms clearly must meet the concerns of the majority, they also must protect the choices of the minority - especially when those choices touch on basic religious practices.
Much of the legislative work was finalized behind closed doors under a tight deadline. Insufficient attention has been given to alternatives - particularly those ``not invented by this party.'' If employers are required to provide insurance, for example, they should be allowed to offer a ``cafeteria'' from which an individual worker could pick coverage based on his or her needs; workers could contribute pre-tax earnings to help pay for the coverage. Even then, coverage should allow for alternative forms of care without imposing economic penalties for selecting them.
If a bill passes - not a sure thing - the margin is likely to be thin. This strongly suggests a lack of bipartisan support on a subject that urgently demands it.
In this climate, Congress should put the project on hold until the next session convenes in January. Clinton still will deserve credit for energizing the reform process. Meanwhile, states are adopting variations on several of the proposals in question. It may be wiser to see what experience reveals about them before they become the law of the land.