Facebook Twitter



Health-care reform has by now degenerated to such a point that the choice is no longer left vs. right byt good government vs. bad. There is no possible justification, ideological or otherwise, for reforming one-sixth of the economy, almost $1 trillion worth of intricate transactions involving millions of players and thousands of parts, on the back of an envelope in a frenzy of late night horse-trading.

Attempts to bend and stretch and mold and merge the warring health plans floating through Congress in search of some hybrid that can buy off enough special interests and summon 51 votes in the Senate have terrified even the most ardent health-care advocates. "Never has the best of American health care been in such peril" writes Joseph Califano in The Washington Post. Califano, no partisan Republican, was Jimmy Carter's HEW secretary and one of the architects of Lyndon Johnson's Great Society.Why? Because the current rush to legislate creates extraordinary potential for abuse, miscalculation and general mischief "in the feeding frenzy of special interests as they circle several thousand pages of fine print in bills no member of Congress has read or fully understands." It does not matter whether you are a conservative or a liberal, whether you favor the status quo or single-payer. This is no way to do reform.

Last month this column warned of the impending collapse of the free vaccination programs the Clintons had launched last year in a heavily publicized preview of Clintoncare. This week it did collapse. The administration finally abandoned its plan to take over distribution of a third of the nation's vaccine supply by shipping it out of a government warehouse in New Jersey.

In this case, as Sen. Dale Bumpers, D-Ark., explained, "a fairly simple law, designed to benefit a relatively small group of uninsured children, was transformed into a bureaucratic nightmare that put the safety and availability of a third of our nation's vaccine supply at risk." Imagine what happens when a monstrously complicated law, designed to benefit a large group of uninsured --and remake the whole system, to boot -- is enacted.

Or consider the Medicare Catastrophic Coverage Act, another small corner of health care that Congress set out to improve in 1988. That bill had a nifty new drug benefit for the elderly that the Congressional Budget Office estimated would cost $5.7 billion annually. A year later, the estimate more than doubled. Another goody --the skilled nursing care benefit --was estimated at $2.1 billion. A year later, the estimate sextupled to $13.5 billion.

The elderly, who were to bear the brunt of these costs with higher taxes ("supplementary premiums" collected by the IRS!), rebelled. The bill was repealed.

"History teaches two lessons about federal health-care reform," warns Califano. "It will cost more than any reasonable estimate at the time of enactment, and it will provoke a bevy of unintended consequences." When enacted in 1965, Medicaid was supposed to cost $1 billion a year. It now costs over $80 billion. Part A (hospital insurance) of Medicare was supposed to cost $9 billion in 1990. It cost $67 billion.

Now we are getting last-minute patchwork plans coming out of hideaway Senate office -- "Chafee," soon "Chafee-Mitchell," then "Gephardt-Chafee-Mitchell" -- that one day are said to add $300 billion of debt and the next day are found miraculously to save $100 billion. Everyone knows the numbers are phony -- not by intent but because they project the interactions of a system too vast and tangled to yield anything but wild guesses. That is what happens when, as CBO director Robert Reischauer puts it, "Congress is trying to make changes that are more complex than anything Congress or the executive branch has considered...probably since the founding of the nation."

Imprecision, underestimates, unintended consequences would be reason for hesitation even if the country knew what kind of health-care reform it wanted. But after two years of debate there is nothing approaching a national consensus for a major restructuring of the system, let alone for any particular restructuring. The current manic rush to find some concoction that can squeak through both houses in time for campaign use in November is bad government at its worst. "In something this big," says Sen. Pat Moynihan, D-N.Y., "either you have 80 votes or you have 40. Nothing like this ever passes with 52 votes, or if it should, it won't last."

The American health-care system is too complex and too entwined with entrenched interests to be rationally reformed in one fell swoop. Certainly not a swoop hastily executed to meet the election year needs of incumbent congressmen and a wounded president.

The kind of clean, lean bill that Califano advocates cannot possibly be improvised by legislators eager for a Labor Day holiday and the start of the '94 campaign. It is time to stop, take health care to the voters, then come back and do it next year with more order and less hubris.

"Does anything ever work out in August?" asks Moynihan. "You know, the French take August off. Maybe they know something."

Congress, go home.