The Government's Elitist Approach To Health Care

NEW YORK - "A top administration health adviser said most of President Clinton's health plan is `pretty much done,' " The Wall Street Journal reported in a short article last week. "Among the major decisions remaining, Mr. (Walter) Zelman said, are how to finance the health-care plan . . . and what specifically should be in the standard benefits package."

Oh, is that all? Right! The possible meanings of that statement cover the usual Clinton White House range, from (1) they do not have the slightest idea of what they're doing, to (2) they're backing off, or (3) holding off for political reasons. I assume it's a combination of (1) and (3), because the president is being told that he can handle only one fight at a time and the issue of the week is his economic package.

But there are those in high places who think (2) is the way to go. Rather than wrestle with the doctors, the hospitals, the insurance companies and the pharmaceutical companies at the same time, to say nothing of corporate and labor America, the president (and his wife) could just let their good intentions drift along into the great beyond of unkept campaign promises.

If Mr. and Mrs. Clinton do back down or hold off too long on a health-care plan, they should spend the time and political capital saved to look over universities searching for leaders, or law firms looking for big names, because Mr. Clinton will be a one-term president for sure.

Clinton's problem with the nation on this one is that we believed him. Most of us spend our lives talking with nobody listening - that includes Arkansas governors and hot-shot lawyers - but when presidents speak, people not only listen, they change their lives. There is a sense of urgency out there. Ordinary people and companies, many of them quietly desperate, heard Clinton quite clearly and have been counting on the government to do something about health and health insurance - providing what used to be called a safety net for all Americans.

This one is a classic example of the growing gap between the American elite, including the people high in government, and everybody else. Because senators and other federal employees and the assorted VIPs who actually get the chance to talk to the president usually have the most comprehensive of health plans, they have a distorted view of how frightened millions of less-lucky Americans are about this.

I have been amazed first, and then shocked by the number of people I know who've told me they were against national health insurance or thought it was not necessary because government coverage would never be as good as what they now have. The last person I heard that from was a prominent liberal Democrat covered by the policy of a great university. "I don't want to give up what I have now," were the exact words.

Lucky them. And what they saw on the editorial page of that same day's Wall Street Journal was this headline: "Americans Don't Want a Health-Care Revolution."

Wanna bet? What you hear outside Washington - and not just from poor people - is that companies are using the prospect of national insurance to cut back on their own plans. And you hear from a lot of people with such mundane problems as children losing family-plan coverage when they finish college and either not being able to get a job (and their own separate coverage) or getting a job with no fringe benefits at all.

I don't think they get that in Washington. Federal employees have what amounts to a separate health-care system, just like the separate and elite system reserved for communist bureaucrats in Moscow before the breakup of the Soviet Union. Whatever reform Clinton pushes, if he does, will preserve a separate system for those with the money to pay for it. But the rest of the country is going to need something a little more basic.

A long time ago, the American people decided that such health-care reforms as clean water and vaccination programs were government responsibilities. Now, as far as I can tell, a public consensus has been reached on new levels of health care. If the president is not hearing that from his political advisers in Washington, he really does have to get out into the country more and hear what is being said there: Just do it!

(Copyright, 1993, Universal Press Syndicate)

Richard Reeves' column appears periodically on editorial pages of The Times.