All right, let's try to get this straight. Once, a few months ago, there was President Clinton's health-care reform plan, with its glowing promise of insurance coverage for all and quid pro quos, among others, of payroll and cigarette taxes. There were other schemes, too, introduced by such luminaries as Senator John H. Chafee, champion of individual mandates, and Representative Jim Cooper, friend of small business. Surely, reform was at hand.
Those bills are history now. Instead, we have five major committees, three in the House and two in the Senate--plus 15 or so lesser bodies--all cobbling reform legislation. Most are wrestling with chunks of the President's plan, but shreds of Chafee and Cooper--not to mention Stark, Breaux, Dingell, and McDermott--are floating around, too.
CUT AND PASTE. All five committees promise to complete bills by July, though it looks already as though some won't pull that off. Then, the House's bills will go to the Rules Committee, where the Democratic leadership will jury-rig them into one package. The Senate's majority leader, with committee chairs, will merge its bills, then deliver the result for a weeks-long floor debate. And a joint conference committee will meld final legislation from the two survivors.
With us so far? Of course you're not. No one is. The legislative process on health care has been "kind of a subway train that's hurtled into a tunnel," says Michael J. Langan, a vice-president at benefits consultant Towers Perrin. "You know it's speeding along, but you don't know where."
To be fair, we're starting to get hints: Switch on C-Span, and you can watch elected officials plow through entertainingly arcane legislation. (Sample: "I haven't actually read this, Mr. Chairman.") It doesn't look good. Expectations for a law that approaches the scope and impact of the President's original were scaled back long ago.
The House Ways & Means Committee leans toward basing a standard benefits package on what's now provided in Medicare--because its health subcommittee oversees Medicare. Energy & Commerce is hopelessly sidelined, because the legendary arm-twisting skills of Chairman John D. Dingell (D-Mich.) have met their match in the lobbying clout of small business. And the idea of forcing business to pay for universal coverage has moderate Democrats running for cover.
Can anyone be surprised? This is the way the conservative U.S. legislative process works. And from the start, health care has been a classic example of ego- and interest-driven politics. Its breadth, a product of Presidential ambition, ensured it would touch on nearly every lawmaker's turf. Its prominence--and the dollars at stake--guaranteed everyone would want in on the action.
BOSS KNOWS BEST. The Clinton reform plan, though Byzantine and fiscally flawed, at least was characterized by relatively consistent thinking. It reflected the goals and ideals of the boss, more or less, and--again, more or less--provided a sense of synthesis, of closure, of means and ends. Introduce the same issues into Congress, and the dynamics produce a Frankensteinesque monstrosity. "Our adversarial form of government is not well-suited to developing a tightly integrated health-care system," says Thomas O. Pyle, an early member of the President's health task force.
Where all this is headed, it now appears, is legislation proposing voluntary targets for enrollment and benefits. Missing the targets by Year X would set off triggers for mandatory programs.
In other words, Congress would get to defer responsibility but still argue that it had ensured the President's beloved universal coverage, sort of. The finances would be a lot easier to swallow. Clinton could claim victory. And everyone would pass the buck to the states and the market, which are fast overhauling health care, anyway.
Maybe that's not entirely bad. But markets don't have all the answers, and states aren't likely to address such issues as insurance reform. Congress' display of collective spinelessness may prove more than drawing-room entertainment. It may actually hurt.
Hammonds covers health care issues.