Washington. -- Commentary on the demise of health-care reform in the 103rd Congress has missed the major reason for the defeat of the Clinton administration in the legislative struggle.
In the move to restructure one-seventh of the U.S. economy, the administration tried to reweave the social fabric of the country into a pattern that members of Congress and their constituents refused to don. The debacle that ensued resulted in the loss of legislative momentum, political capital, respect for the first lady and likely a number of seats in both houses of Congress. It may also portend an unfavorable election result for the president in 1996, if the reform he endorsed truly represents his vision of America.
When Mr. Clinton was elected almost two years ago, the country was ready to move on health care. Even the health-insurance industry supported reform; a proposal issued by the Health Insurance Association of America called for doing away with pre-existing exclusions, job-lock and cherry picking, along with an employer mandate. It was acting not out of compassion or altruism but the realization that the insurance industry had better budge or risk being left behind.
The arrival of the Clinton plan was anxiously awaited. Senate Majority Leader George Mitchell, D-Maine, reportedly held the symbolic first bill, S. 1, for it, hoping that health-care reform would be passed quickly and set the tone for a productive legislative session. By the time it was finally introduced, over six months later in November of 1993 (by then S. 1757), it was obvious that the bill's reach far exceeded the scope of health-care reform.
In congressional testimony, every witness, liberal or conservative, stated that any reform must concentrate on three areas: access for the uninsured, cost containment and maintaining quality. Much of S. 1757 was about other things. Ira Magaziner, who headed the effort, was described by Michael Rothschild, president of Bionomics Institute, thus: "If you're looking for a social engineer, Magaziner is the best." The emphasis on social engineering rather than health-care reform doomed the effort.
Abortion was one example. Under S. 1757, everyone, irrespective of personal conviction, would pay for abortion services. Abortion coverage was subsumed under the phraseology of "pregnancy-related services" in section 1116. In all the abortion debates, no one has ever attempted to classify abortion as a problem of access, quality or cost containment. Including this social issue under the guise of health care immediately aligned over 150 votes against the bill in the House alone.
Family-planning services expanded the reach. Condom distribution, availability of other contraceptives and abortion counseling were covered with no guidelines concerning the age of the patient or provisions for parental consent. Homosexual couples were recognized as marriages. Everyone had to pay the same for the same package: Personal beliefs and choices were overridden by government fiat. Sex education was also covered.
Generous mental-health benefits, broadly defined, got into the bill. Senate Finance Committee Chairman Daniel Moynihan, D-N.Y., has observed that American medical costs are so high because we now define societal problems as medical concerns. He cited depression and alcoholism, "mandated benefits" that insurance policies in many jurisdictions, by law, must offer at great additional cost. There are now over 1,000 mandated benefits across the country, ranging from hair transplants to heart transplants. Many, including alcoholism and depression, would have been covered by the definitions of S. 1757.
"Mental-health" provisions would have allowed anyone to check himself into a hospital for therapy (or a warm bed and hot meal). Thus health-care reform was utilized to guarantee shelter and counseling to every homeless person or anyone who demanded it. As most homeless people have mental or substance-abuse problems, hospitals would be turned into de-facto shelters. While the homeless are a tragedy, this is not what a hospital is for. More than any other provision, these mental-health costs would have proved to be the budget breaker.
The race or ethnicity of your doctor also came under S. 1757. Quotas were set for medical-school classes and professions to ensure that there was a politically correct balance in the 'N health-care community. Affirmative action was the goal here, not health-care reform.
Insurance-industry support was lost by the emphasis on government controls rather than market incentives. Everyone would buy a government-dictated package from a government-regulated regional alliance at a government-set price. "Harry and Louise" never attacked health-care reform, they attacked government control and social engineering as found in S. 1757.
Social problems and issues need to be debated and dealt with on their own merit and import, not brought in under health-care reform through expansive definitions. Local referendums, ballot initiatives, direct legislation and other methods are available to resolve these issues. Instead, the Clinton administration piled all its good intentions into one massive package. When it collapsed of its own weight the needed health-care reform failed, too. The 104th Congress may profit by the example.
NB Jonathan Paul Yates is an aide to Rep. Roscoe Bartlett, R.-Md.