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COLUMN RIGHT/ JAMES P. PINKERTON : Goal: an Offer Americans Can't Refuse : Any health-care plan will involve compromises, but it must work for most people.

March 18, 1993|JAMES P. PINKERTON | James P. Pinkerton, former deputy assistant to President Bush, is the senior fellow at the John Locke Foundation in Raleigh, N.C.

The flap over Hillary Rodham Clinton's role in formulating a new health-care plan does not obscure the reality: The buck stops on Bill Clinton's desk.

National health insurance has been a Democratic cause since Harry Truman proposed it in 1945. The coming debate over Clinton's plan will affect every American: Health care consumes $800 billion a year, one-seventh of the U.S. economy. The struggle will dwarf Clinton's economic "stimulus" package, defense cuts, national service, even the debate about whether Vice President Gore has been replaced by a Macy's mannequin.

Success for Clinton is vital to all Democrats. This is their Big Offer to the American people. The history of American politics can be thought of as the story of one party seeking to trump the other by making a Big Offer to the voters.

Consider the Big Offer that Abraham Lincoln's Republicans made to black Americans in 1863: freedom. Emancipation was a great moral decision, but it was also a smart political move. As a result, in good times and bad, blacks stayed intensely loyal to the party of Lincoln for three-quarters of a century.

Franklin Roosevelt's Democrats made a Big Offer to the working class in the 1930s: labor unions, agricultural price supports, the minimum wage. For decades, the Democrats kept their side of the bargain, and in return, the voters kept theirs. The New Deal coalition didn't begin to unravel until the 1970s, as changes in the economy--and unimaginative Democratic leadership--made much of Roosevelt's legacy obsolete.

In 1980, Ronald Reagan made a new Big Offer: a 30% across-the-board cut in tax rates. In addition, he immunized taxpayers from inflation-driven "bracket creep" with indexation. The domestic "gridlock" of the 1980s is the story of the face-off between two popular Big Offers: Reagan's tax cuts vs. the still-potent remnants of Roosevelt's programs, most notably Social Security.

George Bush won in 1988 because he promised to preserve Reaganomics ("No new taxes"). Unfortunately for the GOP, Bush broke that pledge in 1990. The voters punished him for retracting the Republican Offer: Bush's showing in 1992 was the worst for a GOP incumbent since 1912.

Enter Bill Clinton and his Big Offer: cheaper, better health care for everyone.He faces one obstacle that past Democrats didn't confront when they tried to enact national health insurance: changed times. Reagan didn't just cut taxes; he undercut the faith that bureaucratic government can work. And the definition of a successful Big Offer is not that it makes everyone happy, but that it works for most people.

The Clintons have outlined their definition of success for their plan: universal coverage, controlled costs. They cite the very real problems of people who can't get coverage because of pre-existing conditions, of workers who can't move because they'd lose their coverage. The Clintons think they can cut through the wasteful red tape and stupidity of the current system to deliver a good product to the voters. They hope that the downside--less choice, higher taxes--will seem small by comparison.

Clinton has a lot going for him in this fight. Higher taxes on cigarettes and alcohol are common-sense incentives to stay healthy. Many employers look forward to offloading their health insurance hassle onto the government; better to have employees mad at Uncle Sam than at them. Clinton's diabolization of drug companies also appears to be working. Never mind that the biggest factor in rising drug prices is the cost of liability, driven by Clinton's Untouchables, the trial lawyers. The bottom line is that every successful campaign Clinton strategist James Carville has run involved demonizing something; Carville doesn't intend to start losing now.

Finally, don't underestimate the political skills of a Democrat smart enough to cultivate past Republican presidents, even inviting Richard Nixon to the White House.

The only problem will be the health-care plan itself. Clinton has more faith in bureaucracy than most of us do. Maybe the Administration can develop a plan that avoids the rationing that leads Canadians, for example, to come here for non-routine procedures. My guess is that about 10 minutes after the President signs a bill, Americans will figure out how to "game" the new system. The cleverest doctors and lawyers in the country will match wits with bureaucrats. Guess who will win.

For Americans who missed out on the opportunity to own a savings and loan, this will be that rare thing in life: a second chance to milk the government.

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