With Health Plan, Clinton Follows Steps of FDR, LBJ

THE timing of the century's great entitlement programs indicates that President Clinton's health-care proposal has at least caught a certain historic rhythm.

Social Security, the centerpiece of Franklin Delano Roosevelt's New Deal and the biggest American social program to date, was enacted in 1935. Medicare and Medicaid, the biggest-ticket items in Lyndon Johnson's Great Society proposals, were enacted in 1965. If Mr. Clinton's proposal survives relatively intact, it will join the ranks of those programs in its sweep and impact, and its passage would very likely come around or before 1995.

But the cycles of history are not all in Clinton's favor.

Both 1935 and 1965 presented what historian Edward Berkowitz of George Washington University called ``real moments of congressional tolerance for presidential initiatives.'' Presidents Roosevelt and Johnson both seized those moments for grand initiatives.

This year, by contrast, is a time of low tolerance in Congress for presidential initiatives, similar to when an unpopular Harry Truman unsuccessfully proposed single-payer national health insurance in 1945.

Clinton is launching his proposal into a more direct democracy than Roosevelt, Truman, or Johnson faced, with scores of radio talk-show hosts broadcasting from the White House lawn, televised town meetings where the president himself answered questions from the public, and the thrust and parry of network advertising campaigns by supporters and opponents.

``That tells you something about how the climate has changed,'' says Hugh Heclo, a political scientist at George Mason University in Fairfax, Va.

FDR broadcast a fireside chat about the need to ``refurbish'' the government to serve people in an industrial era, but Social Security was relatively unpopular with the public when it passed. After all, it would start drawing payroll taxes in two years and not pay its first benefit until after five.

But the 1934 congressional elections had just brought in a flock of new Democrats in an impressive endorsement of the earlier New Deal programs. Roosevelt had nearly a ``blank check'' on Capitol Hill, Dr. Berkowitz says.

Likewise, in 1965, Johnson was still in the shadow of the Kennedy assassination and was fresh from the largest landslide election in history. The Civil Rights Act had already passed, settling some controversies that might have snagged his Medicare and Medicaid proposals.

It was a window that Johnson himself knew would not stay open long, because of the Vietnam War and civil unrest.

Neither Roosevelt nor Johnson undertook a serious effort to sell these programs to the public. Power was more closely held by elite establishments than in today's ``much more fluid and open environment,'' Dr. Heclo says.

Johnson's battle to pass Medicare was primarily with Rep. Wilbur Mills (D) of Arkansas, chairman of the House Ways and Means Committee. Once Mr. Mills had reshaped the program, passage was relatively routine.

Truman's proposal for national health insurance ran into a brick wall of resistance from the medical establishment. The American Medical Association aggressively lobbied Congress against the plan as ``socialized medicine.'' The charge tapped into then-prevalent fears of communist conspiracy.

Clinton, of course, will not face arguments that tap into the Red Scare. Nor will he face many arguments pitting individual self-reliance against government guarantees of health care.

``The culture's changed,'' Heclo says.

But Clinton will face a vastly diminished faith in government which, in the Johnson era, was ``almost absolute,'' Heclo says.

As radical and unprecedented an expansion of the federal government as the New Deal was, Social Security was a relatively conservative option for Roosevelt against pressure for more populist, more radical programs that distributed federal funds directly to the retired.

Clinton lacks such a cover of a more radical movement to fend off. The single-payer, Canadian-style health-care system has considerable support but is not a popular movement. Clinton has stepped further out in front of his political environment than Roosevelt did, says Elizabeth Sanders, a political science professor at Cornell University and a student of the New Deal.

Many historians note that FDR's campaign for Social Security had less of a free-lunch character than Clinton's proposal.

Roosevelt spoke upfront about costs. In fact, an important element of popular support for the program has always rested on the perception that it was a contribution-based insurance policy, not a government handout.

By contrast, Clinton downplays the need for new taxes to pay for his ambitious social program.