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Starting Over : Domestic Issues: Is Lack of Focus the Problem?

July 03, 1994|Suzanne Garment | Suzanne Garment, a contributing editor to Opinion, is a resident scholar at the American Enterprise Institute. She is the author of "Scandal: The Culture of Mistrust in American Politics" (Times Books)

WASHINGTON — The party-line vote in the House Ways and Means Committee last week, where the Democrats prevailed, is not enough to pull President Bill Clinton's version of health-care reform out of the deep trouble it is in. Though people say they like the plan's goals, one recent poll disclosed that they disapprove, by 53% to 42%, of the plan itself. The same poll showed the public trusts Congress more to handle health care properly.

The response of the President and Hilary Rodham Clinton to the bad news, as well as to his generally low approval ratings, was to declare last week the week of the Great Midterm Shakeup--in which a President says that now everything will be OK because he has just sacked his old chief of staff (or communications director, or secretary of state) and gotten himself a new one. Clinton has moved his childhood friend, Thomas F. (Mack) McLarty III, out of the chief of staff's office and replaced him with former Rep. Leon E. Panetta--a "Washington insider," the reports emphasize--who moves to the White House from his current job as head of the Office of Management and Budget.

The President is said to have chosen Panetta because he has the skills needed to deal with Congress on health-care reform and produce a sorely needed win--or to help with White House and congressional midterm campaign efforts if the win does not materialize.

Is this shift likely to change the President's fortunes? Not much. In health care, as in most of the domestic policy arena, Clinton's troubles lie deeper than problems of political or communications skills. His message is not getting through because White House ideology has made for policy incoherence, and the issue of character has robbed both the President and Mrs. Clinton of authority.

Panetta has the experience and temperament to cut a health-care deal on the Hill. One of his first acts was to talk with Senate Finance Committee Chairman Daniel Patrick Moynihan (D-N.Y.), whom he has known for years. This is already a big improvement in White House-congressional relations.

But Panetta may have little control over the most important obstacles to a successful deal.

Clinton was quite right, during the 1992 presidential campaign, to identify anxiety over health insurance as a worry that dogged many Americans--and thus as an area in which the call for "change" would have concrete appeal to a great many.

Others have also recognized the pervasiveness of the insurance worry. In fact, nowadays the policy air hums and buzzs with possible solutions to this insurance puzzle. They range from mandatory catastrophic insurance to assigned-risk pools and medical savings accounts.

But when the Clintons finally produced their health-reform legislation, it turned out not to be clearly focused on the insurance problem. Instead, it aimed to do many other things as well: For example, to shepherd people into government-run "alliances," speed the shift to health-maintenance organizations, control the prices of drugs, rationalize the conduct of health-care research, control the number of medical specialists and use employer mandates to avoid hitting most Americans with a direct tax bite.

The plan certainly did not look as if its sights were trained on the pressing matter of health insurance. It did not seem focused on the issue of health-care quality. Its scope made it look more concerned with power: the power to control decision-making in the health-care system.

Hillary Clinton helped foster this impression by talking of the plan in terms of a large transfer of power. In launching the health-reform campaign, she stressed the need for people to take control of the system from insurance companies tending their profit margins and the drug companies price-gouging on children's vaccines.

But this rhetorical strategy and the plan's general approach did not do well. Parts of the rhetoric fizzled: It turned out, for example, that drug companies did not make big profits on vaccines, and that the rise in vaccination costs was due mainly to doctors' fees. Moreover, Mrs. Clinton's ability to make persuasive "greed-and-power" arguments declined after revelations of her own profit-taking in the commodity futures business.

Meanwhile, the plan's voluminous, overreaching character produced--well, lack of focus. The same features raised the suspicion that, in supporting the plan, people might be buying into more change than they really wanted. By being so inclusive and ambitious, the plan also identified itself with trends, like the HMO's, already proceeding but which many people still feel ambivalent about.

Doubts of this sort made people receptive to advertising and other kinds of persuasion from those special interests that Mrs. Clinton says are the root of all opposition to health reform. In fact, a series of ads sponsored by the Health Insurance Assn. of America, featuring "Harry and Louise," is regularly cited by the Administration and others as particularly effective in attacking the plan.

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