Selected Skirmishes: Stayin' Alive

Health, wealth, and wise guys


Just as Ronald Reagan's red ink made the electoral world safe for a Balanced Budget Amendment, the Clinton administration's greatest gift has been to discredit the notion of sweeping health care reform. That is a considerable consolation prize to the American people, who have–thanks largely to Republican dirty tricksters–had to vote not once but twice for this student council prankster from Hot Springs.

The lure of health care legislation for the fledgling Clinton administration was not simply that it got the Ms. out of the White House. The chief draw was that cute little plastic card Mr. Clinton loved to wave: Don't leave home without it!

At the time it oozed of genius. In 1991 and 1992, Democrats feeling the pain of middle class folks downsized out of their health insurance were hitting nerves. They were zeroing in on people's fears of financial insecurity better than at any time since the New Deal.

Mr. Clinton's health care card would not only sweep your risk away, but the administration's policy wonks had ingeniously rigged a mechanism to control skyrocketing health care costs to boot. Wasn't it time that we tackled this great problem? "Experts from across the political spectrum agree," wrote the esteemed National Journal in July 1994, "that doing nothing would have the direst consequences….Costs would continue to rise rapidly."

Well, the Clinton plan couldn't even sneak by a Democratic Congress, helping in fact to turn that body Republican. And "experts from across the political spectrum" were proven wrong: The health care cost trend went flatline in the 1994-96 period. Sorry, National Journal. We did nothing–and it worked!

The trick, of course, is that doing nothing in the public policy world allows much more to be done in the real world. Today, thousands of smart people work overtime trying to shave medical costs. Some of these are the dreaded HMO procedure-approval dragons; but others represent consumers, businesses, unions, even prison systems (New Jersey, witnessing a 500 percent rise in state-provided prison health care in the last 10 years, has just started letting contracts to per capita plans). The pressure is forcing people to face up to the trade-offs imposed by real constraints.

The golfing doctors who gripe about managed care are wrong to see it as the end of the free world: It is the end of the free lunch. And the editorial hustlers who crow that the HMO game is the same as the one inspired by HillaryCare are in need of post-traumatic stress medication: A choice among HMOs, other per capita plans, and fee for service, as dictated by market competition, is not the same deal as rules crafted for everyone by committees drafted in Washington. Not unless the Post Office, which also delivers data, is MCI.

In truth, the problems of health care remain substantial; hopefully, the recent authorization of medical savings accounts will spur imaginative new ways to deliver healthy people at lower cost. Advocates of "single payer" systems will yet point to socialist medicine elsewhere as a better buy. But adjusting for quality, as well as for cost inflation associated with U.S. government purchases (Medicare, Medicaid), makes this claim difficult to test.

The Clinton campaign for health care reform was, at bottom, a program to expand government; Ira Magaziner's passion was not aroused due to a lifelong attachment to medical cost cutting. Ira's dream was to give the government more big, important stuff to do. Those of us who believe that the state already has its hands full may want to focus on a very different government health care issue: the witness protection program.

It turns out that, before brave Americans can come forth to testify against gangsters, a sizable number of them are silenced permanently. In one sensational case in Los Angeles two years ago, both a witness and the mother of a witness were gunned down prior to a murder trial.

This inspired a stepped-up effort by the district attorney to protect his people–an altogether logical reaction. Perhaps the barest essential governmental function should be keeping alive our fellow citizens who come forth to prosecute violent criminals. Yet, as the Los Angeles Times puts it, "Two years later, efforts to strengthen the country's witness protection program have gone nowhere."

It seems that the government prosecutors, besides pleading a lack of funds, can't figure out which witnesses really need protection (threats being difficult to document: "Excuse me, Mr. Big Vinny, but would you be so kind as to put that in writing?"). Paralysis is also induced by legal liability. One retired LAPD officer calls the situation "scandalous." He notes that cops are told: "For God's sake, don't ever use the words 'I will protect you' or 'I will try to protect you,' because you have incurred liability.'"

Good legal advice: Taxpayers in Pomona, California, are having to shell out for a 1992 incident in which a prosecutor read a 16-year-old gang member's statement identifying a murder suspect in court–after promising the youngster confidentiality. Looking at the bright side, the youngster only had to live one terror-filled week before he, too, was mowed down, and his family is now collecting damages.

I don't have any snappy answers for this mayhem, but I do have a question: Why don't we try to solve this sort of government health care issue before tackling those which the rest of us might have a shot at? Uncle Sam should try to keep the witnesses in murder cases alive. We'll deal with the cold and flu season.