THE healthy life is something of a national obsession in America - widely advertised, talked about, pursued, but not always practiced. It isn't surprising that this season's Medicare debate, like last year's national health-care debate, tops the list of subjects squeezed into the final weeks of congressional action.
What's regrettable is how little of that debate seems actually to be about health. Much rhetoric and effort are being spent on fear. Much focuses, sensibly enough, on money: premium and co-payment levels, reimbursement levels for specialists and hospitals, malpractice-suit limits, and teaching-hospital funding. And attention is diverted to the supposed inability of older citizens to adapt to change or understand new choices for health care.
Costs are certainly important. Fundamentally they are a way of measuring how fairly sacrifice is shared as the nation goes about slowing runaway expenses for a comforting national program. There ought to be some equity of sacrifice among (1) older citizens and the disabled facing higher premiums and choices about care that amount to a degree of rationing, (2) younger citizens facing higher Medicare withholding tax from each paycheck, and (3) doctors, hospitals, and insurers facing restricted income. The
Republican majority in Congress and President Clinton recognize that if the Medicare funding system doesn't change soon, fast-inflating costs will force it to change more drastically later.
Too many of Mr. Clinton's fellow Democrats are reflexively trying to scare enough elderly voters to help reverse last year's GOP election tide. If they succeed, of course, they will themselves have to wrestle with the problem, grown worse by another year. And if that means rising payroll taxes to keep the current system going, they will place a heavy burden on each succeeding younger generation. No amount of sophistry about rising paychecks keeping pace with rising Medicare taxes can disguise that fact.
Nor are the Republicans blameless. Their leaders deserve support for having the courage (and cunning) to tackle this notorious ''third rail'' problem without, so far, getting fried politically. But they are not benefiting themselves and the nation by letting it appear that part of the $270 billion saved by slowing the rise in Medicare costs will become a tax rebate for middle- and upper-middle-income Americans. It would be better for national purposefulness if Gingrich, Archer, Dole, & Co. were to postp one their income-tax cut until it's clear that the proposed seven-year budget balancing is really on target. Clinton ought to do the same with his proposed tax cut.
This is a national financial problem that requires bipartisanship - not ''third rail'' electrocution of solution- seekers - if the repairs are to last for more than a few years.
But, as we said at the outset, Congress is legislating about health, not just about ''death and taxes.'' Offices on the hill might do well to tack up a few James Carville-style ''It's health, stupid!'' signs. We tend to get caught up in wonkery sanctioned by the old cliche that the devil is in the details. Let the devil have his due; get the details straight. But don't forget what you're trying to accomplish.
Looked at through the lens of helping more older Americans live healthy lives, much of the detail takes on a different cast.
Take the matter of choice, for example. Both anecdotal evidence and some polls indicate that many older Americans would welcome more choice over how they care for their health.
It's good news that more HMOs are emphasizing staying healthy and preventing disease instead of running a solely cure-and-repair system. Allowing the medical sector to create its own HMOs should further this approach.
PROPOSED tax-free health savings accounts and rebates to those who don't overuse Medicare benefits ''because they're there'' provide rational incentives for older citizens to emphasize health maintenance. Higher co-payments are also an incentive to use the health-care system sensibly.
Recent longevity gains have led to serious investigation of how healthy pursuits and a continuing feeling of being a productive citizen improve the quality of life for individuals too often relegated to shuffleboard, AARP dependency, and grist for actuaries.
The founder of this newspaper, Mary Baker Eddy, wrote much about the underlying meaning of health. In one telling passage she cast liberty and joy as ''strong promoters of health and happiness.'' That outlook seems to have been on the minds of Jefferson and the founders of the American experiment when they chose the words life, liberty, and the pursuit of happiness to describe the rights their experiment aimed to secure. That's the framework within which Washington should be operating on health care tod ay.
Looked at as helping older Americans live healthy lives, the detail of the Medicare debate takes on a different cast.