WHEN a liberal like President Bill Clinton considers a problem like low immunization rates among American preschoolers, he concludes that the problem must be one of cost. If a significant percentage of children are not getting immunized, it must be because the shots are too expensive.
Accordingly, President Clinton last month announced a plan for the federal government to spend $300 million next year to immunize a million youngsters.
The Clinton administration said it was also considering a plan by which the federal government would buy up all of the vaccine produced in the United States and provide it free to physicians and public health clinics.
A conservative approaches the same information about low immunization rates with a different perspective -- suspecting that there is more to the problem than mere cost. Sure enough, the New York Times (mirabile dictu!) and other publications have examined the issue and provided some necessary perspective.
According the Centers for Disease Control, less than half of children between the ages of 2 months and 2 years old are properly immunized. By the time children reach the age of 5, immunization is practically universal, since all schools require immunization as a prerequisite to enrollment.
Is the problem the high cost of shots? Doubtful, says the Times. Twelve states already have free programs in place, and yet their rates of immunization are only marginally higher than states that do not have such programs. Availability? Perhaps. Some working single mothers may not think it's important enough to take the time off work to get their kids to a free clinic.
But that, in turn, points to another possible explanation -- and it happens to be the explanation most frequently offered by pharmaceutical companies -- lack of public education.
Many parents are simply ignorant of what their children need and when. Drug companies argue that Mr. Clinton would be far wiser to spend the $300 million he has earmarked for vaccines on a TV campaign stressing the urgency of getting babies immunized in their first year of life. Twenty-three children died of measles between 1989 and 1991 in New York state alone. Most of those deaths could have been prevented by timely vaccination.
There is one other factor that contributes to low immunization rates, at least among some groups, and that is social decay. Single parents, particularly young single parents, whose own lives are disorganized and chaotic, are less capable of seeing to the needs -- emotional, physical and medical -- of their children.
Beyond missing the complexity of this issue, there are other aspects of Mr. Clinton's response that are troubling.
During the campaign, Clinton operatives stressed over and over again that they were different from the old-style Democrats. "We understand markets," they boasted. But do they? Mr. Clinton seems to think that he can solve the immunization problem by buying up all of the vaccine and having the government distribute it. But there is no undersupply of vaccine. Besides, even if it were the case (and it isn't) that the poor were precluded from obtaining the shots by the cost, why provide free vaccine even to the rich?
Isn't this just the heavy hand of big brother intruding clumsily where it doesn't belong? New Democrats? Bill Clinton blamed the drug companies for failing to lower their prices. Would Walter Mondale do anything different?
Vaccines do cost more in America than in other industrialized countries, but that is for a reason Bill Clinton will never tackle -- liability. A huge part of the cost of a diphtheria shot in the United States is the drug company's insurance against liability claims. If one child out of 100,000 has a bad reaction to the shot, the company could face punitive jury verdicts. So the companies protect themselves with hefty insurance policies and pass the added cost along to the consumer.
Why won't Mr. Clinton take on that problem? Because trial lawyers were among his most generous contributors during the last campaign.
If the president wants to reduce the cost and increase the use of vaccines, he should encourage a public information program and support tort reform.
Mona Charen writes a syndicated column.