In the aftermath of a political season, the first act of which just ended, I am galled by a sense of unfulfilled promise and lost opportunities. So, in an attempt to lift me out of that state of regret and frustration, I have attempted over the past few weeks to focus on a few of my pipedreams -- nice things that might come out of the political or legislative meat grinder in the near future. In my previous installments, I outlined my top three pipedreams: I first stated my belief that people should draft a presidential nominee whether or not that person had taken steps to pursue that goal; I proceeded to make the case for Bill Bradley as the most logical choice. In my second installment, I outlined the hope that our government might actually sign on to a believable committment to get our fiscal house in order, and set down a long-term spending plan to get us to budgetary balance by 2002; I mentioned the worthy efforts both of the Senate's Mainstream coalition led by John Chafee and Breaux, and of the House of Representatives' Blue Dog coalition, as examples of promising leadership which might yet lead to our government successfully tackling this knotty and seemingly intractable problem. And in my third installment, I detailed the very realistic campaign finance reform proposal being pushed in the House by Representatives Linda Smith and Chris Shays and in the Senate by John McCain and Russell Feingold.
Finally, I would like to detail what has been up to two days ago widely viewed as the most likely dream to be realized, that of
Highest on the list of villains in the drama of our national deficits and debt is the rising cost of health care in this country. The fact is that those rising costs lie at the heart, for example, of the threat of bankruptcy now hovering over our nation's commitment to health care for the elderly, the Medicare program. The issue was central to the '92 campaign as first Bob Kerrey in the Democratic primary campaign, and then Bill Clinton in the general election campaign, stressed the need for this country to accept its responsibility as a society to make health care affordable and available to all. Much was made of the fact that our country enjoys the melancholy distinction of being one of the few nations in the world who do not guarantee their citizens cradle- to-grave health coverage. It is an exclusive, small, and somewhat infamous club. At one time, South Africa was a fellow member.
Most of us probably remember what happened after the '92 election. Through a combination of inept and/or nonexistent use of the bully pulpit on the part of newly elected President Bill Clinton, and a demagogic and highly efficient smear campaign launched by a superbly organized opposition led by the National Federation of Independent Businesses, the health reform push collapsed amid a sea of recrimination and blame, and managed to turn the cause of health reform into one of those so-called third rail issues in American politics.
The Clintons made so many mistakes in that effort that it is hard to know where to begin our discussion attempting to make sense of that failure. However, the one major overarching error of which the Clintons were guilty was that of not making any meaningful attempt to build a bipartisan coalition that would stand fast when the winds of special interest opposition began to blow.
This was not the first time that the Clintons, accustomed to operating in a small state where the Republican minority was little more than an irrelevant appendage, gave the back of their hand to feelers extended by Republicans trying to meet them halfway. In early 1993, for example, when they offered their 18 billion dollar economic stimulus package, and it became apparent that Republicans would see to it that the program would never see the light of day, moderate Republican Senator Mark Hatfield offered the Clintons a choice of only a 10 billion dollar program, with a guarantee of enough Republican moderates to pass the proposal. The Clintons said in effect "My way or the highway" and the upshot was this country saw no stimulus proposal at all in the end. This happy backhanding of any helpful feelers from Republicans also saw fruition in the successful votes on the White House deficit reduction program offered in '93, when NOT ONE VOTE came from the Republicans.
It was in this atmosphere that the propaganda war over Hillarycare was fought. The Clintons should have figured it out. Bob Kerrey, the pre-eminent crusader for universal health coverage in '91 and '92, should have given them the hint when he endorsed liberal Republican John Chafee's alternative proposal, a proposal which also included a guarantee of universal coverage. But they didn't get it. So all the efforts of well-meaning centrists in Congress, particularly in the Senate, to fashion an acceptable compromise that at least held out the promise of universality, got nowhere. Primarily they got nowhere because with conservatives like Gramm intoning that health care reform would be passed over his "cold, dead political body," and single-payer off-the-cliffers like McDermott and Wellstone holding out till the bitter end, believing that Clinton would stay with them on the issue of guaranteed universality, the greater body of legislators saw no reason to stick their necks out for a centrist compromise which lacked any sort of coalitional foundation laid by the White House or anybody else.
And it did not have to be. The Mainstream, or Rump, group were so close. Minor issues held them up, -- soft-triggered employer mandates if coverage of 95% was not achieved by a date certain down the road, triggers which might have wound up never being pulled anyway, caps on malpractice awards, another significant source of health cost inflation, a cap on tax deductibility for employer-provided health plans, which would have removed a significant part of the market pressures on insurers to raise rates for those in individual plans, etc. etc. In fact, regarding the latter, I can assure you that I'm one union member who would have been glad to lose some of that tax protection if the trade-off had meant health coverage would never be an issue again in contract negotiations between my union and management, and health coverage would never disappear from my life as a result of my being laid off or changing my job.
Another contributing element to the failure of the push to reform health care in this country lay in the conventions of negotiation currently in fashion in the Congress. Currently, when Congress succeeds in doing anything at all, it usally does so by utilizing a system of consensus-building which I call EXCLUSIVE COMPROMISE. In EXCLUSIVE COMPROMISE, one EXCLUDES anything which might conceivably cause one member or another of a coalition to walk away. The result frequently is easily palatable legislation, law which is easily passed. Too often that result also is spirit without letter, principle without substance, -- meaningless, in other words.
I would urge our public servants to adopt what I call the principle of INCLUSIVE COMPROMISE. When operating under this principle, one actively seeks to INCLUDE at least one highly controversial item from the agendas of both sides, in order to accurately make the claim that everyone had a seat at the table, and that genuine principles were satisfied. In this vein, the Mainstream group should have included BOTH soft-trigger employer mandates, to satisfy the call for universality, AND malpractice award caps, to satisfy the cost-control concerns of conservatives.
In any event, none of that happened, health reform died, and Clinton lost both houses of Congress, and it served him right.
Yet now, despite that fiasco, a respected centrist and a revered liberal have joined forces to produce an incremental health insurance reform which would guarantee health insurance portability from job to job, and severely curtail the ability of insurance companies to withold health coverage on the basis of a pre-existing condition. And wonder of wonders, where Clinton was unable to get his own majority leader, George Mitchell, to even bring health reform up for a cloture vote, the leaders of this effort, Republican Nancy Kassebaum and Democrat Edward Kennedy, have managed to sheperd the bill through both Senate and House passage, following which the bill now stands just one joint congressional conference away from final passage and the President's signature.
Of course, count on Newt Gingrich and his merry men to destroy even this modest, bipartisan effort at alleviating the stress and anxiety so many Americans feel. They are holding the bill hostage to the pernicious concept of medical savings accounts, a mechanism whereby people with the financial wherewithall to save up sufficiently can squirrel their money away into tax-free instruments from which withdrawals for medical purposes can be made without penalty. This account is opened in conjunction with the purchase of high-deductible, catastrophic health insurance policy. Obviously, this means that standard individual insurance accounts will become more expensive as the human pool covered by such accounts becomes smaller and sicker. This brilliant idea is being pushed by Golden Rule Insurance in particular, a heavy contributor to the Dole campaign, and a leading peddler of medical savings accounts.
And now it begins to look as if once again gridlock has triumphed over sober attempts at real governance. Yesterday's Times depicts the Kennedy-Kassebaum bill as close to extinction. If it is so, it will be just another demonstration of what Bill Bradley told us almost a year ago, -- that politics is broken.
So there you have it: my only remaining forlorn hopes for our government this year. I will concede that the pipedream of a truly independent candidate for president this year, unencumbered even by eccentricity or megalomania or billions, let alone special interest and/or PAC contributions, is the farthest-fetched of the four. But there is no excuse, no excuse whatsoever, for our government not to straighten out its financial mess by balancing the budget, not to clean up the subverted and despoiled political system in this country, and not to live up to its responsibility for the health care of its people. So far, our government has failed to do any of those three things, despite the fact that well-meaning people on both sides of the political fence, whether liberal or conservative, whether Democratic or Republican, realize full well that those are tasks which our government uniquely has the responsibility to perform. What it boils down to is that today we have a government that is basically not functioning, a government strangled by the special interests and paralyzed by the propaganda scripts of public relations.
The solution? The people themselves eventually have to realize the need for wholesale change, not only in their votes but in the actions they take and the words they speak and write. But most important, our elected officials must start behaving like leaders, speak impolitic truths, and take impolitic risks. That is why leaders unencumbered by the fossilized structures of the Republicrats continue to offer the best hope out of this policy maze in which we have been trapped for a decade or more.
Or do they? You may disagree; but whether you do or not, you are cordially invited to fill out the boxes below and express yourself. Bear in mind that I reserve the right to quote statements sent to me in this manner, in whole or in part, in subsequent Musings. Also, be sure to indicate in the Title of your Message the name of the Musings, "Pipedreams IV -- My Last Forlorn Hope," to which you are responding. Thank you.
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