"It is a magic moment and we must seize it." With those words, President Clinton called upon Congress to respond to the "ethical imperative" of "providing universal, comprehensive health care" for all Americans. In the weeks since that speech, Hillary Rodham Clinton has tirelessly explained and defended the technical details of the administration's Health Security Act. But even in her most technical presentations, she has never failed to remind her audience of the moral dimensions of this cause.
The Clintons are right. The moral stakes in the health reform battle are enormous, and profound. At issue is the very way we think about health care, and about ourselves as community: Will American society, and its laws, continue to treat health care as just another commercial commodity, to be bought and sold among those fortunate enough to afford it? Or will the United States join the other industrialized nations in recognizing health care as an essential public service, a basic human right, to be made available to all members of the community?
The Clinton administration is also on the mark in its assertion that timing is crucial. If the political struggle of the coming months ends without enactment of real reforms, advocates for health justice will likely have to wait a full generation before the possibility of reform is again within grasp. In the meantime, an inhumane and profoundly unjust system will have only deteriorated further, at great cost to us all.
Congress will, of course, enact something called "health reform," simply because both parties recognize the political necessity of doing so. But cynics may be forgiven for recalling "welfare reform," "tax reform," "banking regulation reform," and the like. Some of these previous congressional "reforms" were only minor tinkering. Others were actually harmful.
In that unhappy tradition, health and insurance industry lobbyists are now pushing their own versions of "health reform" that would be of little or no real value. There is reason to feel that the Clinton plan already concedes too much to the status quo, even before Congress exacts its own inevitable compromises.
The administration proposal is not a single-payer system, like Canada's, in which everyone shares the same health plan. Clinton's use of large "alliances" to broker health coverage hardly abandons the notion of health care as a commercial commodity. On the contrary, the administration's plan uses the brokering concept to simulate the financial dynamics of the free market. The Health Security Act's preservation of the private insurance bureaucracy will perpetuate costly overhead of doubtful value. Reliance on employers to finance much of the health care bill may depress the job market, especially among the marginally employable, as critics charge.
Despite these shortcomings, those who yearn for health justice must acknowledge the political constraints that compelled the compromises which the Clinton package embodies. Those who would oppose the president in favor of wholly different models of reform must realize that such opposition will probably only play into the hands of those who want no change at all. Passage of the national law will still leave to individual states the option of enacting broader reforms, and will provide a foundation upon which future federal reforms can be built.
The challenge, then, is to work within the framework of the Clintons' basic approach to make it as strong an expression of social justice principles as possible. Support for their proposal does not imply uncritical acceptance of its details. For example, the plan to make everyone pay at least $10 for each doctor visit or prescription, regardless of ability to pay, is harsh and unwise. Such co-payments deter timely treatment, resulting in a need for more expensive care later.
Other elements of the Clinton package raise concern for the treatment of undocumented aliens. Still other features could potentially foster continuing discrimination against the poor and people of color. Reformers must seek changes in these parts of the presidential package, while fending off weakening amendments from the other side.
In its campaign to blunt meaningful change, the medical-industrial complex has already spent more than any other special interest in the history of the nation. And Congress knows there's plenty more where that came from. For all the president's claim of bipartisan commitment to reform, the health industry lobby will find plenty of allies among politicians of both parties.
And so this historic struggle for social justice requires the participation of us all. Not just the poor, who have always been shut out of a commercialized system that makes quality care like corn flakes or cosmetics--available only to those who can pay. Not just women, who recognize the gender biases that permeate medical research and practice. Not just civil rights advocates, who well understand that, in America, the availability and quality of health care often depend more on the color of one's skin than on the surgeon's skill. And not just the affluent, who must worry that their own care may be compromised by the system's financial bias toward imposing on dying patients who are well-insured unwanted medical measures that rob their dignity and prolong their suffering.
Not just these Americans, but all of us. This is a historic opportunity to advance the cause of social justice and alleviate human suffering. Many in earlier decades who struggled vainly for health reform would envy us this occasion. None of us should miss the chance to play a part.
Gordon Bonnyman was a legal-aid attorney in Memphis, Tennessee, and a frequent Sojourners contributor when this article appeared.
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