Washington. -- Forty percent of Americans will pay more for health insurance under President Clinton's reform plan. Scare stories to this effect dominated the news over Halloween weekend. Opposition ghouls gleefully pounced on these figures as proving the Clinton plan to be fatally flawed.
The fuss is ridiculous, for two reasons. First, virtually all Americans will pay more for health insurance under Mr. Clinton's reform, other reforms, or no reform.
Nothing will stop the inexorable rise of health-care costs; the best hope is to slow that rise.
Second, the particular reason the Clinton reform will raise some people's insurance costs is that it requires insurance companies to take all comers at non-discriminatory rates. Right now insurers are free to refuse bad risks or charge them a lot more. Obviously, if the companies are henceforth required to "pool" the bad-risk customers with good-risk customers, those good risks -- the young and healthy -- will have to pay more.
But every health-care plan now circulating on Capitol Hill contains a similar insurance reform. Indeed, insurance non-discrimination is even more central to the various Republican alternatives than it is to the president's plan, since they leave out so much else. All these rival plans would also raise insurance rates for the young and healthy. (Even a
Canadian-style single-payer plan does this in effect.)
Did someone say "change"? Change, far from being what everyone wants, is virtually impossible in our political culture. Whose fault is this? I blame Robert Pear of the New York Times. Mr. Pear, who covers health care, is a legendarily scrupulous reporter. But his stories of recent weeks, since Mr. Clinton's big health-care speech, form a pageant of political paralysis.
Consider. September 30: "AMA Rebels Over Health Plan." October 11: "Clinton Care Plan May Cut Benefits to Some Children." October 18: "Heads of HMOs Have Concerns on Health Plan." October 20: "Local Governments May Pay More in Health Plan." October 21: "Business Group Assails Scope and Cost of Clinton Health Plan." October 24: "Influential Group Says Health Plan Slights the Aged." And so on.
Criticism of Mr. Clinton's plan is perfectly legitimate and some criticisms may even be valid. But this cacophony of complaint illustrates the challenge faced by any major social reform. First, many of the complaints are contradictory. Youth advocates complain that the plan favors the elderly, while the elderly complain that the plan discriminates against them. While conservatives charge a "federal takeover" of health care, HMO administrators object to regulation by 50 different states' agencies.
The AMA objects to a "bias toward managed care," while the HMO types -- who ought to be pleased by this -- worry "about their ability to handle a surge in membership." As a sop to the elderly, the Clintonites kept Medicare as a separate program; elderly lobbyists now complain that the standard package for the non-elderly includes some benefits not in Medicare. Meanwhile children's advocates complain that merging Medicaid into the larger system will reduce some benefits -- not for the poor, but for the near-poor.
If I were President Clinton, I would cut a deal in a hurry. I would invite Senators John Chaffee and Bob Dole, co-sponsors of the most palatable Republican plan, and Rep. Jim Cooper, who's pushing a self-described "Clinton-lite" bipartisan alternative, up to Camp David for a weekend, and settle this. (OK, Hillary can come, too.) Because the longer Bob Pear and his ilk are allowed to roam the landscape kicking interest groups until they bark, the more it will seem as if Mr. Clinton's reform plan is full of terrible disadvantages that rival plans somehow magically avoid.
Mr. Clinton might be reluctant to make a quick compromise on health care because the current take on him is that he's a trimmer. "One of the enduring questions," writes the magisterial R.W. Apple of the Times, "is whether Mr. Clinton has specific policy goals in which he is willing to invest his political capital." In fact, that is only this month's question. Six months ago the question was whether Mr. Clinton was proving to be a hardened left-wing ideologue whose refusal to compromise betrayed his promise to be a "new Democrat." He cannot win this game. So why play it?
Some form of health-care reform is pretty sure to pass. The political danger to the president is that he won't get the credit. Ronald Reagan managed to get the lion's share of credit for the 1986 tax reform, even though it originated in a revolt against his earlier tax bills.
Mr. Clinton put health-care reform onto the national agenda. But for his victory last year, Republicans would have been content to let the problem fester. Whatever emerges will be the biggest expansion of the welfare state in decades. Yet there is some risk that, after a year or more of potshots, the GOP will present the ultimate product as a defeat for the president and a victory for conservatives who saved the country from Clintonite big-government socialism.
Cut a deal, Mr. President. Quick. Before Robert Pear strikes again.
TRB is a column of The New Republic, written by Michael Kinsley.