Health care transcends flap over open meetings ON POLITICS


WASHINGTON -- There is less than meets the eye in the controversy here over whether the health-care task force led by Hillary Rodham Clinton should open its meetings to the public and press.

The truth of the matter, as the plaintiffs in the lawsuit unquestionably are aware, is that there is no way in the world for government decision-making to be forced entirely into the open. Even when the law requires particular meetings to be public, the officials cannot possibly be restrained from private discussions over a cup of coffee at which points of disagreement are most likely to be hammered out. That's the way the world works.

In this case, the federal judge who ruled against the administration applied his open-meeting edict only to sessions of the full Task Force on National Health Care Reform that are designed to gather information. There's nothing onerous about that; on the contrary, the task force already has planned a series of public forums around the country to solicit testimony on the flaws in the health-care system.

Quite beyond the question of what restrictions are practical, however, lies another fact about this situation. Although the problems of the health-care system are both complex and formidable, the various approaches to solving them have been out on the table for discussion for several years.

Nobody is expecting some silver bullet solution to appear. The alternatives already have been studied to death. What has been lacking has been the political will, in the White House and in Congress, to deal with the health-care problem in a serious way. So the responsibility for President Clinton, assuming he has the political will, essentially will be to choose among options already well known.

The goals of the program also have been fully defined. Clinton will be seeking a system that guarantees basic coverage for all Americans whatever their medical histories, allows workers to change jobs without losing their coverage and ultimately reduces the insurance costs imposed on both employers and workers.

Moreover, the president already has indicated the broad outlines of the program he is likely to propose sometime later this year. He has always been opposed to the "single payer" system that would make health care directly financed through the government and he has always favored some form of "managed competition" -- meaning a system that preserves the major role for the private health insurance companies.

It has also become clear, although Clinton obviously doesn't put it in these terms, that the president wants to squeeze the health-care providers into reducing their fees and, as a result, insurance costs.

All this being the case, it is clear that the lawsuit to force open meetings, brought by health industry organizations, has been designed to raise questions in the public mind about whether the process leading to the new program is legitimate. It will surprise no one if the plan that finally emerges is not first attacked as a "secret deal" put together without adequate consultations with the industry itself.

Moreover, the presence of Hillary Rodham Clinton as head of the task force, although she is not a public employee, gave them the legal and political opening. Her special role in confronting this issue is something new and entirely different for a first lady. And it has not been totally accepted by the electorate, although a new poll has found she still gets "positive" marks from 54 percent of the voters compared with "negative" grades from 23 percent. On the question of whether she should be "involved" in policy, the public is clearly divided -- 48 percent saying she should, 45 percent that she should not.

The root question should be whether Hillary Clinton would be qualified to lead this task force if she were not the wife of the president and thus eligible to serve on the public payroll. And the answer clearly is that her professional credentials are good enough so that few eyebrows would be raised if that were the case.

But the stakes in health-care reform are enormously high -- for the industry itself, for the Clinton administration and for the millions of Americans who are either not covered or inadequately covered today. By comparison, the question of whether the task force meets publicly or privately is small potatoes.

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