Health Care Redux

Shades of eight years ago. The top two Democrats vying for the White House next year are crossing swords over the issue that helped usher Bill Clinton into office: health care reform.

Of course, it also dealt Mr. Clinton an early political defeat once he was in office - a setback that did much to elect a Republican Congress in 1994 and set a pattern of executive-legislative friction.

So Bill Bradley and Al Gore join battle with a mix of zeal and caution. Mr. Bradley, however, has damned the torpedoes in this instance. He proposes a sweeping plan to make existing federal health insurance plans much more accessible through subsidies and tax credits, and to create health-care vouchers for the poor. Waving a true-Democrat pendant, he claims the plan would boost health coverage to 95 percent of Americans - at a cost of $65 billion a year.

Mr. Gore, a battle-scarred veteran of Washington's health-care wars, derides the Bradley plan as too expensive and as likely to cut out some of the poor who now use Medicaid. He counters with a more incremental plan to expand federal health-care plans for children and the elderly.

It's noteworthy that neither candidate is reviving the most controversial aspects of the Clinton plan, such as mandates on all employers to provide coverage and a medical ID card for all Americans.

As sparks fly, polls show that only 6 percent of the public are paying much attention to this debate. As earlier in the decade, politicians who call health care a "crisis" demanding a "big solution" (Bradley's phrase) carry a big burden of proof.

That's doubly true as Congress gears up to address some of the questions - such as who makes treatment decisions, doctors or insurers - the public finds most bothersome about the current managed-care system. One major insurer, United Health Group, has settled that question on its own in favor of physicians, putting down a marker for the industry.

Yet health insurance is still a salient political issue. Some 44 million Americans don't have health insurance. The current campaign sparring could build from a Gore-Bradley duel to an important part of next year's general election, with Republicans forced to come up with their own perspectives.

In recognition of that possibility, here are a few things for all candidates to keep in mind:

Cost containment remains a central concern. The country's new-found fiscal balance could all too easily be lost to a poorly conceived universal health insurance plan. The reconciliation of cost and some form of universal access to care remains a central dilemma of health-care reform.

The confidentiality of health records is crucial. Any credible proposals should put that concern front and center.

The most basic issue in health care is not universal coverage but universal choice. People who want mainstream medical care should have it. Those who rely on other means of care must be able to exercise those options free of government interference.

If there's to be another, more successful, attempt at reform, more care must be taken to build a public consensus and embrace an approach that serves all Americans.

(c) Copyright 1999. The Christian Science Publishing Society

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