What Clinton could learn from the catastrophic health care catastrophe - President Bill Clinton, Medicare Catastrophic Coverage Act of 1988

Washington Monthly, March, 1993 by Greg Monfils

By the fall of 1988, House and Senate members started backpedaling--not on the benefits, of course, as this would only further incite the special interests-but just on the financing. Instead of attacking the problem at its root, which would have meant showing the courage to peel back some of the overloaded benefits, and thus eliminating the need for unfair financing methods, Congress had taken the easy way out and simply upped the tax rates. This brings us to lesson number two for the Clinton administration and the new Congress: Special interests such as doctors and insurance companies will continue to fight tooth and nail to protect their wallets against health care reform. The easy way out will be to appease them. Doctors may not like the fact that health care reform means they'll have to hold onto their Volvo a couple more years before buying that Jaguar, but that's not a valid reason to buckle to their demands.

As important as remaining wary of the well-connected will be remaining mindful of the least organized, who are also most in need; namely, the 37 million Americans without health insurance. When the catastrophic care act was repealed, the soft voice of the elderly poor was, not surprisingly, drowned out by their wealthier counterparts. Only strong political leadership could have prevented this.

Simply stated, the people most likely to benefit from the act, the elderly poor and the spouses of the elderly ill, lacked the financial wherewithal to effectively voice their concerns. This, combined with the fact that they do not vote as dependably as their more affluent contemporaries, made them a lower priority in the eyes of many lawmakers. The effort by Congress and the Bush administration to defend the act on behalf of these people proved to be laughably inadequate. At first, seniors nationwide received pamphlets filled with all but indecipherable bureaucratese describing the complex components of the act. What's more, there were no longer any defenders with enough visibility or credibility to stop the repeal effort. Senator Claude Pepper, the great defender of the elderly, had died, Reagan was gone, and President Bush didn't lift a finger to save the act.

That's a mistake Clinton cannot afford to make --which provides the third and most important lesson: While both Reagan and Bush supported the plan, neither made it his mission to sell it to the American people. Clinton--not a Cabinet secretary, not leaders of Congress--must step forward to speak for the millions most in need. If Clinton uses his presidential bully pulpit to emphasize the need for doctors, hospitals and insurers to make a legitimate sacrifice in income so that the nation is not bankrupted by health care costs, he may not win over the American Medical Association, but at least Congress and the rest of the country will be encouraged to stand up to it. Then, when patients get an earful from their doctors about how they'll suffer from health care reform, they'll be ready to fight back.