Washington.-- It was surreal and revealing when in his post-election press conference President Clinton said:
"On the health-care issue, I will concede that by the time the folks who were characterizing our program had finished with it -- and one of your publications said that they thought about $300 million had been spent lobbying against the health-care reform -- it looked like a government program designed to solve the problem by restricting the choices of the American people and injecting the government more into health care."
Sen. Pat Moynihan, asked recently who had misunderstood Mr. Clinton's plan, the president or the people, said: "The American people got it clear enough," adding:
"There were two cost-containment provisions in that bill. The first was to cut the number of doctors in the country by a quarter. . . . If you have fewer doctors you have fewer doctor bills. But you don't associate it with improving medicine. And two, let's just cut the number of specialists in half."
From the hundreds of thousands of documents generated by the 500 people who toiled for Hillary Clinton's task force, Senator Moynihan cites a memo signed by 13 of them critical of the president's proposal to cap the number of resident physicians in training. That cap, combined with the administration's plan to raise the ratio of medical generalists to specialists, expresses this administration view: Each physician is a "cost-center," generating costs by receiving a salary, ordering tests, admitting patients to hospitals, etc.
The critics who wrote the memo noted tartly that "controlling demand by limiting supply is perverse." And they said that when presidents of major universities were apprised of the proposal to restrict entry into the medical profession, they were "incredulous" that policy would aim to limit access to a learned profession "with its millennial history of achieving social good" and its recent history as a "path for immigrant social mobility."
In a letter to the New York Times August 28, Mr. Moynihan, refuting a column headlined "Swamped With Specialists," argued that general practitioners are a function of demography -- you need, say, 85 per 100,000 people. However, specialists are a function of science: New discoveries create new specialties. Said Mr. Moynihan, "We are not swamped with specialists; we abound in them. And that is surely the glory of this great moment of medical discovery."
The next day, Walter Reich, M.D., director of the Program on Health, Values and Public Policy at the Woodrow Wilson International Center for Scholars, wrote to Senator Moynihan about the threat of "a deliberate dumbing down of medicine":
"The idea that one should avert the expense of medical procedures by getting rid of the specialists who understand or carry them out, or by making sure that new specialists aren't trained, makes as much medical sense as getting rid of the possibility that a person will experience future illnesses by prophylactically removing all of his healthy organs at an early age. That organ-free person will surely never get, say, pancreatic cancer or hepatitis because he no longer has his pancreas and his liver; but neither will he be able to survive very well or very happily for very long."
Government limits on the training of specialists is, Dr. Reich wrote, anti-intellectual, anti-scientific and "by anybody's definition, anti-life." It is, he said, "even medieval" to curtail medical expenses by curtailing expensive knowledge:
"This approach is so illogical and strange that characterizing it as medieval does a profound disservice to what was, in comparison to this age of anti-medical-scientism, an intellectually luminous epoch. Attempting to dismantle the edifice of specialization seems akin, somehow, to the deliberate torching of the great library in Alexandria."
Now, re-read President Clinton's press conference statement above. Disregard his silly lament that he, armed with the entire executive branch and backed by many private interests, could not get his program understood by the public. But note this: Most people still do not understand, as Senator Moynihan and Dr. Reich do, the plan's worst features.
Regarding Mr. Clinton's bizarre claim that his plan would neither restrict choices nor inject government further into health care, a plausible explanation is that so low is his opinion of the public, and so high is his estimate of his cleverness, he thinks he can say anything and get away with it. The 1994 elections suggest not.
Mr. Clinton's health-care deception, the centerpiece of his presidency, flowed from his 1992 campaign, itself a long deception in which he presented himself as someone opposed to the sort of statist excess that his health-care plan was. The 1994 elections were condign punishment for both deceptions.
George F. Will is a syndicated columnist.