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Why Health-Care Reform May Be Beyond Saving

August 14, 1994|William Schneider | William Schneider, a contributing editor to Opinion, is a political analyst for CNN

WASHINGTON — Comprehensive health-care reform is in big trouble. Here's the reason: President Bill Clinton has lost the support of a crucial political ally--the middle class.

Without the support of the middle class, the odds are against the President on health care. Those odds worsened considerably last week with Clinton's stunning defeat in the House of Representatives on the crime bill.

Members of Congress weren't afraid of the President. They figured there was no price to pay for defying him. Imagine what would have happened to a congressman who crossed Lyndon B. Johnson or Ronald Reagan on a vote like that.

In politics, where there's no fear, there's no clout. If the President couldn't get members to cast an easy vote on a popular measure like the crime bill, imagine how hard it will be to get them to cast a tough vote on health-care reform.

That wasn't the way it was supposed to be. Clinton got elected President as the champion of "people who work hard and play by the rules." That's what being a "New Democrat" means. The "Old Democrats" were the ones who wanted to tax the middle class to pay for social-welfare programs for the poor.

Now look at what's happened. A CNN-USA Today-Gallup poll taken last week asked people who they thought would benefit most from health-care reform: "upper-class Americans, the middle class, the poor, or everyone about equally"? Answer: the poor. Who did people think would be hurt most by reform? Answer: the middle class.

Now, this is strange, because what created the health-care issue in the first place was middle-class panic. The recession of 1990-91 had a devastating impact on white-collar employment. It created a terrifying prospect for middle-class workers who had no unions to protect them. Losing their jobs meant losing their health insurance--and their families' health insurance. To make matters worse, health-care costs were rising out of sight. Individual health insurance was unaffordable. Medical problems carried the threat of impoverishment.

It was Harris Wofford who showed Democrats the way in November, 1991. He asked a devastating question: If every criminal has a right to a lawyer, shouldn't every American citizen have a right to a doctor? With that, Wofford trounced the Bush Administration's stand-in candidate, former Atty. Gen. Dick Thornburgh, in the Pennsylvania U.S. Senate election.

Clinton took up the health-care issue and rode it all the way to the White House. He even figured out how to make sure the issue appealed to the middle class. Clinton insisted throughout on "universal coverage." Universal means available to everybody; in other words, not means-tested. If a program is means-tested, the benefits go to the people who need them the most, i.e., the poor. And the middle class pays the bill. That's Old Democratic thinking.

The definition of the middle class in this country is simple: neither rich nor poor. Middle-class people know there are people poorer than themselves. They know government programs based on "need" will help poor people, because their needs are the greatest. Government programs like Social Security and Medicare are not based on need. That's why they are politically sacrosanct. They help everyone, whether they need it or not. That's why such "entitlement" programs are so expensive: You have to bribe the middle class to support programs that only incidentally help the poor.

Clinton deliberately modeled his health-care plan after Social Security. Remember the health security card he held up in his State of the Union speech last January? It looked just like a Social Security card. It was supposed to. Clinton figured that his dogged insistence on universal coverage was the key to winning the middle class.

Democrats played to the middle-class fear of losing health insurance. In introducing his bill Tuesday, Senate Majority Leader George J. Mitchell (D-Me.) called it a matter of "simple justice." He said, "The difference between secure coverage and unaffordable policy can be as heartbreaking as one sick child. That's not fair or right. That's why we need reform."

But Republicans discovered another middle-class concern--that the federal government will have too much control over the nation's health-care system. Senate Minority Leader Bob Dole (R-Kan.) said the "Clinton-Mitchell bill" was based on "the principle that government knows best." If the bill passed, Dole warned, "the federal government will have broad and sweeping new powers in almost every aspect of health care."

Last week's poll tested those two fears. Which concerns Americans the most--that Congress will pass a plan that gives the federal government too much control over health care, or that Congress will pass a plan that fails to guarantee health insurance for every American?

Bad news for Clinton. Too much government was a bigger concern than too little health insurance, by 53%-40%.

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