NATIONAL HEALTH: NOT IN OUR TIME

This "Year of Health Care" may end up like all the other years of this century -- with no national health care. The president's progress towards his principal goal is as becalmed as his approval rating. Presidents are only as powerful with Capitol Hill as they are popular with the voters. When the polls are good, the White House gets its way in Congress. Conversely, when the polls are bad, presidents are rebuffed.

Bill Clinton had a tepid electoral mandate (43 percent) and perhaps the shortest Congressional "honeymoon" of any 20th century president. By the time his experts cranked out the Clinton health plan, Clinton had begun to lose some of his Oval Office clout. He could only ask for Congressional support; he couldn't command it.

Americans want the best and cheapest medical treatment on earth. Any plan that will fulfill that goal is okay. But no plan will. The voters now are being asked to choose between an existing system that worries them -- escalating costs, lack of portability, pre-existing illness restrictions -- and a future system they cannot comprehend.

It's a Hobson's choice between worry and fear. The worrying insured outnumber the frightened uninsured. For the moment, there simply isn't compelling pervasive dissatisfaction amongst the people to cause them to demand sweeping change.

Theodore Roosevelt, Franklin Roosevelt, Harry Truman, Lyndon Johnson and Richard Nixon all, at one time or another, sensed a groundswell for a national health plan. However, Americans with jobs where employers automatically pay the lion's share of the costs outnumbered Americans left at risk on their own. Those who had were unwilling to risk what they had for those who had not. In a nation of brothers' keepers, Americans wanted to keep what they had for themselves and not worry about the brothers.

The present system is going to cost increasing billions of dollars. The present system cannot contain costs. Some HMOs and some group plans with discounted prices will help. But overall, medical expenses in the present patchwork system will climb substantially. Health care's massive bite out of our economy will over time become a gluttonous feast. Who will pay?

Employers already offering health care will be asked to fork over much more. Employers will tell employees that higher costs for health care coverage will be paid for by decreasing the amount otherwise available to pay salaries. Workers will of necessity have to pay a larger portion of their health care costs. The number of uninsured will grow and hospital emergency rooms -- the doctors of last resort -- will be manifestly unable to dispense satisfactory medical care to 15 percent of the American people.

Government, federal and state, will struggle and fail to constrain escalating Medicare and Medicaid costs. Hospitals will grow increasingly weary of insurances companies and governmental entities "second guessing" their decisions. Doctors will continue to fulminate in a state of exasperation and isolation.

Legislation blossoms in the weeds of dissatisfaction. Theodore Roosevelt's national health care, now close to one hundred years in germination, is still not ready to bloom. The weeds aren't thick enough. Some day they will be, with escalating costs constituting the weed enhancer.

National health care will come when the Fortune 500 scream: "Costs simply have to be controlled on a national basis." National health care will come when the typical citizen believes he's paying too much and receiving too little. In short, national health care will come when the national psyche takes on a Munchian tinge.

But by then, Clinton will be long gone. He will join the century long list of presidents, Democrats and Republicans, who gave a look to health care. But Clinton, unlike his predecessors, gave health care more than a look. He will be second-guessed for his strategic timing and for the complexity of his package. If health care were the essence of his presidency, why wasn't he prepared to move on it early on? Candidates run on concepts and often have difficulty translating a simple campaign concept -- universal coverage, for example -- into functional reality. It's easier to devise a 30 second political spot than to restructure our nation's biggest and most vested business.

In the 1994 Congressional elections, conventional wisdom has the Democrats taking a bath. Health care is politically dead until the 1996 campaign. The "Comeback Kid" will then have to be at his best to ignite some grassroots fervor for an issue that has both bedazzled and befuddled the shrewdest presidential minds. Theodore Roosevelt will have to wait for the next century to see his goal fulfilled.

~Tom Eagleton is a former U.S. senator from Missouri who is a columnist for the Pulitzer Publishing Co.