WORLD

PROGNOSIS: POOR

Vocal lobby groups stall President Clinton’s bid to offer affordable health insurance

CARL MOLLINS March 14 1994
WORLD

PROGNOSIS: POOR

Vocal lobby groups stall President Clinton’s bid to offer affordable health insurance

CARL MOLLINS March 14 1994

PROGNOSIS: POOR

WORLD

Vocal lobby groups stall President Clinton’s bid to offer affordable health insurance

CARL MOLLINS

The scene is a middle-American living-room in the evening, featuring Harry and Louise, a middle-class couple approaching middle age. Harry, carrying a basketball, enters with teenage son Matt. "Good game?" asks Louise, seated on the sofa. "Oh, well," Matt replies, "I let him win." Harry playfully shoves the ball towards Matt and sends him out of the room with, "Time to hit the books, bud." Then, glancing at the book Louise is reading, Harry says: "Health-care reform again, huh?"

Louise hands Harry the book:

‘This plan forces us to buy our insurance through these new, mandatory government health alliances.”

Harry: “Run by tens of thousands of new bureaucrats.”

Louise: “Another billion-dollar bureaucracy.”

Harry tosses the book down:

“You know, we just don’t need government monopolies to get health coverage to everyone.”

Louise: “Congress can fix that.”

Harry: “And they will, if we send them that message.”

During that TV commercial, which has aired repeatedly across the United States this winter and made Harry and Louise celebrities, a close-up shows the

target of their scorn, President --

Bill Clinton’s proposed Health Security Act. The 30-second spot ends with a graphic showing a telephone number “for the facts you need to send Congress a message.” The questions planted by that message, and other ads in a similar vein, have not only stalled Clinton’s bid to introduce universal health insurance but cast doubts among his allies that the President can forge a compromise to solve what even his opponents agree is a national health-care crisis.

Harry and Louise are creations of the Washingtonbased Health Insurance Association of America, which represents about 270 companies. Their $18.3million campaign is reinforced by mailings to about 300,000 callers, according to campaign spokesman Dan DiFonzo. The message reflects the insurance industry’s opposition to Clinton’s proposal for a system of “managed competition,” in which new regional purchasing co-operatives (“alliances”) would work to hold down the price of premiums paid by employers, employees and government. The industry’s campaign has been attacked by both the President and Hillary Clinton, who denounces it as “a desire to obstruct and derail reform, period, and to retain the status quo.” But by the time the latest blitz of commercials

REPORT FROM WASHINGTON

closed late last month, they seemed to have accomplished their mission.

If the job was not done by the TV couple alone, there was widespread agreement in Washington last week that real-life critics have doomed pivotal features of the Clinton plan. The 1,342-page legislation, the centrepiece of his reformist policies, was drafted by a White House task force led by Hillary Clinton. The President unveiled it in September as the fulfilment of his promise to deliver affordable private medical and hospital insurance for all. That includes the estimated 34 million people who, unlike the Harrys and Louises, are shut out of the system because they cannot afford insurance, are denied coverage because of prior chronic ailments, lose their coverage when they lose their jobs or exceed a limit in benefits.

Clinton says that his plan will not only provide lifetime coverage for all Americans. He argues that it will also stem soaring costs. Currently $1 out of every $7 spent in the United States goes to health care, a heavier burden than in any other industrial country. (Canada’s medicare system absorbs $1 out of every $10 in national income.) For months after Clinton presented his plan last fall, polls showed that although many Americans did not

fully grasp its details, substantial

majorities approved of the program in general. But by last week, the tide had turned. As the Clinton legislation sat stalled in several congressional subcommittees, even his allies acknowledged that it would not survive intact, if at all. Worse, say some reformers, the confusion sown by critics, and by a jostle of competing proposals, threatens to destroy any prospect of meaningful reform in the near future. Clinton himself remained optimistic, at least publicly. “I think we’ll get it done,” he insisted after a late-February Gallup survey recorded almost a dead heat: 46 per cent of respondents favored his plan, while 48 per cent opposed it. Only a month earlier, Gallup found 57 per cent in favor and 38 per cent opposed. Clinton blamed the shift on “the millions and millions and millions of dollars that have been spent by interest groups to trash the plan.” Clinton’s plan ran into trouble right after he told Congress on Jan. 25 that he would veto any bill that fails to “guarantee every American private health-care insurance.” One by one, key groups went public with criticism. The American Medical Association, warning that the President’s plan would put medical standards in the hands of bureaucrats and business administrators, launched a $2.2-million advertising

VITAL SIGNS

A recent five-year study by health-care professionals found that Americans spend far more per capita than Canadians on hospital care—even though Canadians visit emergency wards more often, are more likely to be admitted for treatment and, once admitted, tend to stay there longer.

WM CANADA ■■ UNITED STATES

Emergency hospital visits per 1,000 people

Average hospital stay, in days

Hospital admissions per 1,000 people

Average cost per admitted patient (1987)

Source: D. Re4elmeier, V. Fuchs. New EnglandJournal of Medicine

One reason for the discrepancy is that the American health industiy incurs higher overhead costs.

Percentage of health spending devoted to administration

Source: D. Himmelstein, S. Woolhandler, New England Journal of Medicine

campaign that asked: “Would you rather trust your life to an MD or an MBA?” The Business Roundtable, consisting of 200 top executives, endorsed a far more modest reform plan sponsored by Democratic congressman Jim Cooper of Tennessee. The U.S. Chamber of Commerce joined the National Association of Manufacturers and the National Federation of Independent Business in opposition. Business, and many doctors, balked at the Clinton bill’s price controls and its requirement that employers pay 80 per cent of employee insurance premiums.

While business steps up its attacks, other interest groups are sniping on the sidelines. The conservative Christian Alliance has launched a $1.9-million U.S. advertising and lobbying campaign against the Clinton bill. Abortion-rights groups are waging a $13.5-million campaign insisting that abortion should be covered by insurance, as Clinton has promised; abortion opponents naturally disagree. The American Hospital Association, representing 4,900 institutions, endorsed Clinton’s idea of universal coverage but also Cooper’s no-controls approach.

Not all is gloom for the White House and its staff of spin doctors holed up in what has become known as the “Health Care War Room.” Clinton has the backing of organized labor and such corporate giants as Chrysler Corp. and American Airlines. And the biggest lobby of all, the 34-million-member

American Association of Retired Persons (AARP), supports the Clinton bill “as the strongest and most realistic of the plans on the table now,” association lobbyist John Rother said last week.

Almost drowned out by the clamor are supporters of Canadian-style government medicare. Its advocates include four doctors’ groups with a combined membership of almost 100,000, including the American College of Surgeons. And a Canadian-style medicare bill introduced by Democratic Representative Jim McDermott has 92 co-sponsors in the 435-seat House of Representatives, more than any other proposal. But even advocates of the McDermott bill concede that none stands a chance of passage without compromises.

What concerns such reformers is that Congress may be unable to produce a suitable hybrid law. That seems unthinkable in a nation that took its first firm steps into national health insurance in 1965—two years before Canada— with programs designed to protect senior citizens, children, disabled people and low-income adults. Still, says the AARP’s Rother: “There is a real fear that we could end up getting no action this year.” But there is also awareness that in a congressional election year, few Democrats savor the prospect of going to the voters in November emptyhanded on health care. The politics of survival may yet prove to be the beleaguered Clinton’s last, best hope. □