Copyright 1999 The National Journal, Inc.
The National Journal
October 16, 1999
SECTION: POLITICS; Pg. 3018; Vol. 31, No. 42
LENGTH: 1521 words
Why Health Care's Back
BYLINE: William Schneider
The many, many Americans who have
moved into managed care are
worried about their loss of rights.
The House and
Senate have now passed separate versions of
health care reform legislation.
Meanwhile, on the campaign trail,
Al Gore and Bill Bradley have laid out
their own proposals. All
the recent attention ensures that health care has
emerged as a
major issue in the 2000 presidential race, which raises a key
question: Haven't we been here before? The answer is yes--and no.
the problem is the same--millions of Americans who don't
coverage. In fact, the problem's gotten worse. The
Census Bureau has just
reported that the number of Americans
without health insurance has grown by
4.5 million since Bill
Clinton was sworn in as President. One in six
Americans now lack
coverage. But no, the debate is
different from six years ago. Then,
the country was just coming out of a
painful recession. Middle-
class Americans were terrified at the possibility
of losing their
health insurance. Hillary Clinton told a Pennsylvania town
meeting in November 1993: ''Every one of us in this room, even if
have health insurance today, because our country cannot
guarantee us health
care coverage, we cannot know that we will
have health insurance this time
The Administration came up with a bold
guarantee coverage for all Americans--''a system of comprehensive
benefits that are always there, that can never be taken away,''
President described it. But the economy started to
improve, so middle-class
Americans felt less threatened. And
opponents depicted the plan as a
bureaucratic nightmare. That was
the point of the Health Insurance
Association of America's now-
legendary ''Harry and Louise'' ads. Polls
showed that Americans
were overwhelmingly satisfied with their medical care
health insurance. What they were afraid of was losing it. People
became worried that the government wasn't just trying to protect
health coverage. It was trying to take it over.
the time the issue came before Congress in 1994, more
concerned about what would happen if the plan
passed (54 percent) than about
losing their health insurance if
it failed (30 percent), according to a
Gallup Poll. And as the
economy continued to pick up speed, the health care
to go away. When Clinton took office in 1993, only 23 percent
Americans said they were satisfied with the availability and
affordability of health care in this country. By the beginning of
second term in 1997, that number had risen to 41 percent.
So now, with the economy booming, inflation low, and job
creation at a
record high, why is health care back on the front
burner? Because more and
more Americans have moved into managed
care. The issue now is not loss of
coverage. It's loss of rights.
Back in 1994,
Americans in managed care plans and in
traditional fee-for-service plans
were about equally likely to
rate their health insurance coverage as ''very
good.'' By 1998,
those in traditional plans were still satisfied (51
not the people in managed care plans. Their confidence had
dropped to 29 percent.
Today, managed care
accounts for almost nine in 10 people
whose health care is covered by their
employers. They're unhappy.
That's the crisis. It's a middle-class
problem--a crisis of the
insured. But wait a minute. What about the growing
Americans who don't have any health insurance? Many of them are
poor; others are women coming off welfare, children, and
noncitizens--people who don't have much of a voice politically.
why politicians have learned to be cautious.
reform proposal, Gore talked first about the
rights of those who are already
covered, then about covering
children, and finally about making ''progress''
for all. ''As President,'' Gore said on Sept. 7, ''I will
our nation to the goals of universal rights for those who have
health coverage; universal access for all American children; and
progress toward access to quality, affordable health care
for every American
The difficulty now is the same as it was
Opponents will be able to depict the reforms not as protecting
what the middle class already has, but as taking rights away.
House bill passed last week, Assistant Senate Majority
Leader Don Nickles,
R-Okla., promised he would ''work very
aggressively to make sure we don't
pass a bill which increases
costs or increases the number of uninsured.''
Before the managed care reform bill
Republican leaders tacked on a provision creating tax breaks
help the uninsured buy coverage. Speaker J. Dennis Hastert, R-
defended the provision saying: ''The most important patient
protection is to
provide health care coverage for people who do
not now have it.'' But the
real motive was to try to kill the
bill, which allows patients to sue HMOs
and grants more choice in
selecting doctors, by peeling off Democratic
oppose what they regard as tax breaks for the affluent.
It's the same story now as in 1994. Middle-class
over managed care are driving the issue politically. But the
crisis of the uninsured exists largely outside the middle class.
Candidates like Gore and Bradley are trying to package them
one crisis. But as the President and the first lady
learned five years ago,
and as GOP leaders in Congress are fully
aware, the insured and the
uninsured have very different
October 19, 1999