Health-care reform's poor track record

In 1991 Harris Wofford won an upset victory in the Pennsylvania senatorial race, in large part by emphasizing the need for national health insurance. Thus encouraged, the Clinton administration produced a comprehensive health-insurance scheme that collapsed in 1994 without even a vote in Congress.

Helping to engineer the defeat was the health-insurance industry, with a $13-million media blitz featuring "Harry and Louise," a fictitious couple who thought "there must be a better way."

Fast forward to this week, the administration and congressional Democrats pushing a modest patients' bill of rights that would make managed health organizations liable in cases where the patient dies after treatment is refused. The Health Benefits Coalition, the managed care umbrella group, has saturated TV with another appealing couple worried about regulation. The debate in the Senate this week was over a tiny piece of the great American health-care crisis, in which 43 million people have no coverage, and Medicare patients complain of being unable to afford prescribed medicine.

For 50 years, since President Truman first proposed comprehensive health insurance, I've watched as initiatives to put America on a par with other industrialized countries in financing health care have blossomed and withered under the resistance of doctors, hospitals and, more recently, health-care managers. A proposal in the Johnson administration for Medicare-like coverage for children - Kiddycare - did not get very far. Nor did a proposal in the Carter administration geared to low-income people. A catastrophic insurance plan was adopted by Congress and signed by President Reagan in 1988, only to be repealed in a firestorm of protest over increased premiums.

The notable exception to this sorry litany is Medicare and Medicaid, signed by President Johnson after a titanic struggle.

History teaches that reform generally happens only when it becomes politically irresistible - when voters are aroused enough to reward or punish legislators at the polls. The industry's media campaign is directed at keeping opinion from crystallizing against it. That has worked in Congress with health insurance and it has worked with tobacco regulation.

Many Democrats say this time voter consciousness is increasing, and that health care may well be a hot-button issue in the year 2000.

That runs against experience, but, then, there's a first time for everything.

*Daniel Schorr is senior news analyst for National Public Radio.

(c) Copyright 1999. The Christian Science Publishing Society

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