HEALTH CARE D-DAY: CLIINTON VS. DOLE

We are approaching D-Day in Europe and D-Day in the United States on health care. We pretty well know what kind of a health care "system" a majority of Americans would like.

* Total coverage of all health costs for all Americans. "All" means just that -- pharmaceuticals, psychiatric care, bone marrow transplants, nursing home care -- the works.

* The "right" to choose any doctor in the nation. Millions have the delusion that they actually select the hospitals the way they select the movie they attend.

* Health coverage should be for life and cover them fully whether they work, change jobs or whatever.

* Not one penny in additional taxes -- well, maybe, we could tolerate an increase in taxes on cigarettes, brandy, champagne, vermouth and cassis.

Trouble is, of course, that there's no way to provide A-to-Z health care coverage on the cheap. There's no way to rein in costs and lower premiums in the most non-competitive industry in America without some cost and utilization controls. When you are looking for a new car, you decide on what you think you can afford and shop a bunch of dealers to see where you can get the best price. In health care, more than likely, you discover your doctor on the advice of a neighbor, friend or fellow worker. He then runs you through a system of administrative prices set arbitrarily by health providers and insurance companies.

Over the Memorial Day Congressional recess, the two key players on the health care political strategy have to decide what they want as an end result.

President Bill Clinton. His plan is dead. Universal coverage in the near future is politically unattainable. Will he accept a watered-down health plan that talks vaguely about universal coverage at some far off time in the next century? Is he willing to accept a cosmetic triumph proclaiming that the building blocks have been laid for the future? This kind of "victory" would not be a Budweiser, or even a Bud Light, but an O'Doul's.

Or does Clinton dig in, on the middle ground Bud Light and say "Below this I will not go"?

Most Americans are reasonably satisfied with the health coverage they have. Old people on Social Security are pretty happy with Medicare. Blue collar workers with the major labor unions are satisfied with their coverage. White collar workers with big and middle sized corporations like their plans.

Most Americans aren't all that worried about the 37 million Americans with no insurance or with the isolated poor in urban or rural communities where access to health care is very limited. As a people, by and large, we are an out-of-sight-out-of-mind bread. But while most Americans will be happy to keep what they have, they will nonetheless fault Clinton if he fails politically.

Senator Bob Dole. At one time Dole was in favor of substantial reform in the health care system. As a severely wounded veteran of World War II, he probably has more first hand knowledge about hospitals than any other member of the Senate. Like Clinton, Dole has his own political dilemmas. He wants to make one last bid for the presidency. He knows that you cannot win the Republican presidential nomination without some support from the far right.

The rule of the political road in Republican politics is that you have to drive in the far right lane to win the Republican nomination, but then move to the center lane to win the November election. But does Dole, in the final analysis, want to be remembered as the man who killed health care reform?

Clinton and Dole, unlike in many respects, have one thing in common -- they are both total-immersion politicians. Each man wanted to be president from the earliest days of his career. One has achieved it; the other anxiously waits.

The ultimate political decision on health care will have something to do with words like "universality", "alliances", "employer mandates", "portability", "premium caps" and "cost containment". It will have even more to do with how Bill Clinton and Bob Dole perceive their chances of winning the 1996 presidential prize.