President Clinton's speech on health-care reform has set the stage for one of the most complex debates in the nation's history. That major reform is needed is unquestionable. Unless it is checked, health-care spending will consume 20% of gross national product in a few years. That the action is popular is unquestionable. Polls show that an overwhelming majority of Americans support change. That the effort is courageous is also unquestionable. No policy issue is as rife with pitfalls.
But the plan as presented to Congress is flawed. The Administration is simply asserting that it can save enough money from squeezing Medicare and Medicaid to pay for insuring the one-seventh of the population that lacks coverage at any one time. It assumes that there is a huge amount of bureaucratic fat that can be isolated, "monetized," and transferred. As New York's Democratic Senator Daniel P. Moynihan has said, this is sheer "fantasy."
Big questions also remain about retaining individual choice of doctors, government controls, and employer mandates. All will be loudly discussed in the halls of Congress. Indeed, the debate is itself a social good. Americans have been in denial on the issue. For the first time, they are being confronted with the true costs of their own health care.
Fortunately, the reform package presented by the President is the beginning, not the end, of a political process that can produce a better health-care system. If the final plan emphasizes competition and choice rather than controls, if it phases in universal coverage over time, and if it sticks to a basic benefits package, it can succeed in ensuring decent health care for all Americans. They deserve a serious, bipartisan effort to make this happen.