WASHINGTON -- Critics of President Clinton's speech before a joint session of Congress outlining his sweeping health-care reforms are already taking shots at it. It did not provide enough specifics, they say, and its assumptions of cost savings are totally unrealistic. While both complaints may be valid, they cannot obscure the fact that he has confronted the country with a bold and historic challenge.
Not since President Lyndon Johnson in 1964 declared "a war on poverty" has any American president taken on such a colossal task of social engineering. LBJ, bogged down in fighting a shooting war in Vietnam, was perceived in the end as having lost the war against poverty. While he achieved substantial improvements in the lot of America's poor, they never matched his soaring rhetoric.
Clinton's aspirations for universal and protected health coverage are comparably ambitious, and his speech conveyed the dimensions of the changes he seeks. It was in keeping with the upbeat tone of his 1992 campaign rhetoric and raises the question of the public sparks it might have ignited had it been made in the first untroubled days of his administration, rather than eight months into it, when he bears the scars of his erratic and shaky start.
This proposal was at the heart of the Clinton candidacy all last year. Clinton repeatedly argued not only that the health-care system was "broken," as he did again in the speech, but that fixing it was the key to righting the whole American economy. This was the principal "change" he talked about to make the United States once again not only a compassionate but also an economically sound country.
The first indications are that the American people are responding to the broad, general tone of Clinton's speech. A post-speech CNN survey found 67 percent of those polled favorably impressed to 17 percent unfavorable to it and 16 percent on the fence. That suggests he has made a very good start, with the hard work ahead of maintaining public support as the discussion delves into the details and the various special interests take aim.
Unlike other front-burner issues on the Clinton agenda, such as the North American Free Trade Agreement and "reinventing government," most of the special interests in the health-care reform fight will be on one side -- against Clinton. The insurance industry, hospitals, doctors, pharmaceutical companies all are interested in preserving a system that may be "broken" for the rest of the country but is doing pretty well by them in most instances.
Yet the soaring costs to patients and the huge burden of paperwork alone have persuaded even these groups that some reform is needed. That is why only the most conservative Republicans in Congress are dragging their feet on some revamping, and why the prospect for some remedial legislation in the end is good.
But Clinton is calling for much more than that. His particular challenge will be to persuade the electorate, and a majority of Congress, that the ambitious goals he has now set out can be converted to reality in a continuing atmosphere of public doubt about the ability of government to perform. In the months ahead, as the number-crunchers pull the discussion out of the clouds and into mind-boggling cost analyses, the president will have to struggle to maintain the tone of promise for average Americans that he struck in his speech.
In the television age, the politician's objective often is to reduce complex matters to simplicity. Clinton waved a wallet-sized "health security card" that he said would guarantee health care for every American throughout his or her lifetime. To anyone who doesn't have health insurance or faces losing it with a loss or change of job, that card would be golden.
But before it goes from Clinton's hand into the hands of all Americans, a long struggle will ensue in which the dream will have to withstand a broad range of hard-nosed, practical considerations. For now, though, Clinton has given an impressive rhetorical send-off to what is expected to be the domestic centerpiece of his presidency. His place in history could well be determined by his success or failure in revolutionizing the way America cares for the health of its people.