Bush nibbling around the edges of a national crisis On Politics Today


Washington -- SOME CONSERVATIVE analysts are beginning to take predictable shots at the health care plan advanced the other day by Senate Democrats. And many of the criticisms raise questions of obvious validity.

But the Democrats have at least made a start in addressing what is inarguably the nation's most pressing domestic concern. And that is more than can be said for President Bush and the Republican administration.

If there was ever a problem that called out for federal leadership, it is health care. The costs now represent 12 percent of the gross national product, and they are rising by leaps and bounds. Meanwhile, about 35 million Americans have no health insurance at all, and millions of others are in danger of losing their coverage as costs become prohibitive for even some of the most enlightened small employers.

It is, in short, not a problem that can be solved by state and local government, "a thousand points of light" or the good intentions of private industry and the medical profession.

But Bush's only response so far has been a proposal to reduce the costs of malpractice insurance. It is a goal shared by everyone the least bit knowledgeable about the problem, but Bush's plan still represents no more than nibbling around the edges of a national crisis. He has not chosen to be "the health care president."

The Democratic approach is complex. The most critical provision would require employers to either provide private health insurance for their workers or pay a tax, tentatively pegged at 7 percent of their payroll, into a federal fund that would provide the insurance for those employees. This so-called Americare program would replace Medicaid, the existing program for the medically indigent.

The proposal makes an easy target. Some critics point out, for example, that businesses now spending more than 7 percent of their payrolls on health insurance would find it sound practice to abandon their coverage and contribute to the federal pool. Others argue that the whole approach is dangerous because, if the history of similar programs is any guide, the costs are likely to run far greater than the original estimates. Still others say such a plan wouldn't provide benefit levels that would encourage private physicians to treat the patients who are covered. There is the usual grousing about "another federal bureaucracy."

And the fact that the plan was put forward by such vintage Senate liberals as George Mitchell, Ted Kennedy, Jay Rockefeller and Don Riegle is likely to mean that it won't have universal support even among Democrats.

The answer to all these criticisms is simple enough: So what? No one is claiming that the Democratic plan is written in concrete and cannot be refined. The final costs of the insurance can be altered significantly by the breadth of the coverage offered, the deductibles imposed on the beneficiaries and the success or failure of parallel steps to control health costs. But the important thing is that some proposal must be used as a starting point for a national debate that ultimately may provide a national solution.

It is difficult to have a debate, however, when the White House behaves as if there is nothing to discuss. The president loves to review the troops and fly off to economic summits and chew the fat with visiting diplomats. But he clearly has no taste for the nitty-gritty of an issue as apparently intractable and complex as the health care crisis. If it can't be handled with a slogan, then it is not worth his attention.

The answer, obviously, is to force the president into seeing political equities in the health care issue. Whether that is possible is another question. On paper, it appears the voters recognize the seriousness of the problem; new polls show clear majorities would favor either tax-financed insurance or requirements that employers provide the coverage. But it is also true that opinions voiced in the abstract often change when voters are confronted with specific costs -- particularly if there are politicians braying about socialized medicine and big government and wasting money on tax-and-spend liberal schemes.

So the operative question is whether the Democrats who give the health care issue such a high priority can convert it into an issue President Bush can not avoid in the 1992 campaign -- one that might be heard over all the chest-thumping over Operation Desert Storm and how George Bush saved the republic from a "quota bill."

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