by Peter Pratt, Vice President and Senior Consultant for Health Policy
|Despite criticism from many quarters of President Clinton’s national health care reform plan, comprehensive reform will be accomplished by the end of 1994.|
In recent weeks, President Clinton’s comprehensive health care reform plan has taken shots from many quarters. Twice now in four months the president has given a speech on health care reform that a clear majority of the nation finds inspiring only to have detractors peck away at the solid foundation for reform the speeches attempt to build.
The American Medical Association backs down on employer mandates; the Health Insurance Association of America runs provocative, misleading ads; and the Washington Business Roundtable—a group of large businesses that Clinton had looked to for support—endorses the Cooper plan, which does not mandate that employers pay for a portion of their employees’ coverage. Add to these positions the claim of Republicans that there is “no crisis” and the nonpartisan Congressional Budget Office’s report that Clinton’s planners have underestimated the cost of his proposal, at least in the short run, and you have a wounded president on the defensive.
The American public isn’t ready to accept the Clinton plan because it is too detailed and complicated for most people to understand; that same level of detail drives every interest group out of its cave to fight for its little piece of the reform pie. Complexity both befuddles and creates opportunities, depending on the audience.
Beyond Bickering to Compromise
With all of this working against Clinton, we will still have comprehensive health care reform by the end of 1994. It will be a compromise among the Clinton, Cooper, and Chafee plans, not incremental reform. There are several reasons for this.
1. The “no crisis” talk is bunk and just about everyone in Washington knows it.
Even the man who invented the buzz phrase, William Kristol, is backpeddling on his originally forthright stand, as are Sens. Robert Dole and Daniel P. Moynihan. U.S. Rep. Newt Gingrich, who hopes to run against Clinton in 1996 and has a memory, says that those who say there is no health care crisis will be accused, like George Bush, of being out of touch with the American people.
Note that U.S. Rep. Jim Cooper and Sen. John Chafee—whose plans are the chief alternatives to the Clinton plan—agreed publicly with the president that there is a health care crisis. Note, too, that none of the major health care provider groups chimed in with chants of “no crisis.” They spend every day in the health care trenches and know the depth of the problems with our present system.
2. The CBO study and the Washington Business Round-table endorsement of the Cooper plan will accelerate, not slow down, reform.
With very few exceptions, Clinton has indicated a hearty interest in negotiating the major details of his plan. The findings of the CBO and the business roundtable’s support for the Cooper plan will only make him more likely to do so. This will hasten agreements on compromises among Clinton, Cooper, and Chafee.
3. The debate is no longer about whether we will have comprehensive reform; it is about how we will reform the system comprehensively.
The brief shelf life of the “no crisis” idea should convince everyone that even some of the most conservative Republicans fear that their party will be held responsible in the midterm elections if the American public sees them as stonewalling on health care reform.
For years now, the public opinion polls have shown that a clear majority of Americans support comprehensive reform, regardless of whether they are currently satisfied with their own health insurance coverage. They fear rising out-of-pocket expenses and loss of coverage—and Clinton reminds them every chance he gets. A recent poll showing that a slim majority of Americans think health care is a problem and not a crisis is insignificant; a significant majority (63 percent) in the same poll believe that the government should ensure health insurance coverage for everyone.
4. The national media have not even begun to evaluate the alternatives to the Clinton plan; when they do, there will be enough flaws to go around.
There is always a price to pay for leadership. Whatever you may feel about Bill Clinton, you cannot deny that he has the courage to address boldly issues that matter most to people. The president came out with a detailed plan and focused the reform debate on himself—and Hillary. Criticism has come forth over the months.
The Cooper and Chafee plans are new to the media and even newer to the American public. They have so far been treated as more reasonable alternatives necessitated by the flaws in the Clinton plan. Before long, the pendulum will swing back to Clinton as the media seizes upon the shortcomings in these alternatives. Once the flaws of the three major plans are exposed, the necessary compromising will begin in earnest in Congress.
5. H. Ross Perot is on the verge of coming out against the Clinton plan, and if he does for it what he did for NAFTA…
6. When individuals and families understand that they are paying more for health care than they think they are, they will push harder for reform.
At present, most people think they are paying for health care only through premium sharing with their employer, copays, deductibles, and other incidental expenses for over-the-counter medications. In reality, households pay much more. Payroll taxes are dedicated to Medicare, and federal and state income taxes help fund Medicaid and other government programs.
All told, households pay, on average, two-thirds of the nation’s health care bill. Many economists even argue that, one way or another, individuals and families pay for all the nation’s health care. When the public recognizes this, the debate over cost containment will take a very different tack.
7. Finally, the American people want reform, and as they digest more information about the health care system and the alternatives for change, they will be ready to endorse a specific plan for reform.
True, the American people are largely confused about the Clinton plan’s features, as all sides conspire to fog the debate. Even less is known about the alternative plans. But the American people are in this debate for the long haul. They want to learn, and they are plugging away. The questions they ask are becoming more sophisticated and heartfelt than the advertising and sloganeering can answer.
Better information is also becoming available to serve as the foundation for the public’s deliberations. For example, the Kaiser Family Foundation and the League of Women Voters are presenting clear, succinct advertisements explaining our health care financing and delivery problems. The more people read objective information—though no information is completely objective—the sooner they will be able to leave the superficial behind.
Unnoticed by many, we have embarked on a national dialog about health care reform. It is a serious debate that is moving beyond dueling platitudes. In the lexicon of noted public opinion expert Daniel Yankelovich, our dialog is moving beyond off-the-cuff, unconsidered opinions to deeply considered judgments on the new shape our health care system should take.
As the public moves beyond opinion to judgment, it engages an issue much more deeply. It recognizes that there are trade-offs for everyone. It balances the demands of the family pocketbook against the demands of the nation’s social commitments. People are ready to delve into complex principles, like fairness, rather than invoking them only to forestall debate.
Those inside the beltway will help advance the public debate, and the public, in turn, will help advance the congressional debate. In the end, the public will come to judgment on the particular shape of reform.