Substantive health-care reform may be dead for the foreseeable future, but it is very much in President Clinton's interest to keep it alive as his favorite political issue.
The president's grand concept of universal and affordable health care was simply too much for Congress, and the country, to swallow in a hurry. The system choked - it ran out of time, out of ideas, out of political will.But the concept was worth trying, for the well-being of the country. And it is still worth pursuing.
Clinton's prospects for pushing sweeping reforms through a potentially more conservative Congress the next two years are dim. And voters are losing their sense of urgency about health care as the economy improves.
But Clinton is stuck with the issue, no matter what. He billed it as his central bid for a place in history, and he was correct to do so.
The president has hinted that he might yet go for some minor changes to correct the worst abuses of the insurance industry, for which there is considerable bipartisan consensus. That's OK, so long as he makes it clear that such fiddling around the edges is just a down payment on a continuing campaign to pass the rest of his package.
What he cannot do is to advertise marginal modifications as a victory and call it quits.
To cop out, accepting cosmetic legislation that does not resolve the central structural weakness of our health-care system, would merely confirm public suspicion that Clinton does not have the courage of his convictions.
Nor is it clear that the incremental, voluntary bits and pieces favored by conservatives would be an improvement in any case. Budget experts recently criticized a limited, alternative GOP House plan as threatening higher costs and lower coverage standards.
The president has put the issue of sweeping reform on the public agenda, and he is obliged to keep it there, so long as he is in office, until a measure that meets his test of universal coverage passes. (His definition of "universal" is a bit murky, but certain parameters are obvious.)
Clinton failed to break congressional gridlock on the subject, as he had promised. But he has waged a good fight and ought to get some credit for at least addressing the problem, which is more than his GOP White House predecessors ever did.
It was, in retrospect, naively ambitious of the Democrats to expect passage in less than a year of a radical measure that would affect one seventh of the economy. It was only last October that the president sent his proposed legislation to Capitol Hill. Its format changed so many times in the 10 months since that hardly anyone understood what was going on.
The anti-crime bill, by contrast, had marinated in the legislative process for six years and was subjected to hearing after hearing. It addressed an issue that voters give a higher priority than health care, yet it barely squeaked through.
Despite polls that show a majority of Americans favor substantive reform, the complicated health package flunked the basic test of a winning political issue. It was not simple and it was not explainable.
Opponents, deliberately or through ignorance, successfully distorted the issues involved beyond all recognition of the facts.
Industry lobbyists protecting their own vested interests were not the only ones at fault. A major embarrassment was that the logical and fair way to reform the system is simply to give all Americans the same stable, comprehensive benefits plan that federal government employees enjoy. First lady Hillary Rodham Clinton, in fact, tried to shame Congress into doing just that.
But it would be very expensive and result in either new taxes or increased deficits. The Democrats didn't want to go that route any more than the Republicans.
Leading Senate health reform opponent Phil Gramm, R-Tex., confronted with charges of inequity and selfishness, contended his government health plan wasn't really a good deal after all. He claimed that he was as subject to marketplace forces as anyone because if he was defeated for re-election he would lose his health benefits.
This, however, is flatly untrue, as Gramm later had to admit. Unlike many Americans, members of Congress and administration officials can take their health plans with them when they leave government.
House Minority Whip Newt Gingrich similarly tried to poor-mouth his own benefits. He told CNN that he paid $400 a month for his insurance package. Not true. The government, his employer, contributes $300 to his monthly premiums and he shells out only $100 as his share.
The tricky part for Clinton now in the aftermath of his health plan failure is to get what little he can without creating the impression that he is backing away from his core principles.
There will be a great temptation to go on to other subjects, particularly in the festering realm of neglected foreign policy issues. Congress does not like to keep beating a dead horse. The public is easily bored.
But presidents should stand for something, win or lose.