Where Health Care Is Now

EUROPEANS aren't the only ones to use one political issue, the Euro-parliamentary elections, as a way to send a signal on another issue.

Bob Dole, GOP minority leader of the United States Senate, has said that he would be pleased to let the fall elections this year be a referendum on the health-care issue (read: the Clinton presidency). Senator Dole has noticed that President Clinton has returned from Europe somewhat vulnerable.

We have had to refresh our memories as to just what the crisis is, or was, that had to be so urgently addressed by the brand-new Clinton team a year and a half ago.

Many have gone from worrying that nothing will be done to worrying that something will be done, and that it may be the wrong thing. And now with Senator Dole's comments, Republicans and some conservative Democrats may be emboldened into blocking any action at all.

The ``health-care crisis'' is really a cluster of problems.

One is a social welfare problem: 37 million Americans, we are told (the very un-roundness of the figure gives it a ring of truth, if not precision), lack health insurance. This number includes a fair number of healthy, single 20-somethings and self-insuring entrepreneurs, but it also includes a lot of the working poor, many of them just a hospital visit away from homelessness.

There is the competitiveness angle: American companies are out there in the global marketplace competing against foreign firms whose employees' health-care costs are paid for essentially by the state. This has made corporate America an advocate of health-care reform, with an emphasis on cost control.

Meanwhile, policymakers are stuck between the rock of strong public resistance to tax increases and the hard place of resistance to ``employer mandates'' from the business community (especially small business).

Health care is where the gap between the working poor and near-poor, on one hand, and those on welfare and in the Medicaid system, on the other, is glaringly obvious. And the lack of health-care benefits in so many jobs is a sign of how badly the true costs of living in American society have been underestimated.

It would all be simpler if it were harder. Four decades of cold war made US foreign policy simpler, which is not to say easier, than the current period. Similarly, as the president tries to guide Congress and the nation to a program that will presumably emerge as the biggest piece of social legislation since the New Deal, he is without the ``help'' of the Great Depression, which focused national attention during Franklin Roosevelt's White House years.

``During the Clinton administration, a comprehensive health-care program was adopted that covered all citizens and helped contain medical costs.'' This is the summary of his presidency that Bill Clinton is striving for. (On the other hand, if Russia is somehow ``lost,'' or the Balkans ignite World War III, his administration could get characterized quite differently; it might not even get a whole sentence, but just a clause set off with a semicolon, or even a parenthetical phrase.) As one-sentence summaries in the history books go, that's not a bad one. Health care is an issue urgent enough to demand that Congress and the public need to stay engaged - and important enough that they not move in haste.

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