How Americans View Plans For Health-Care Reform

SINCE the great debate began in Washington over the future shape of the country's system for financing health care, there have been determined efforts both to assess and influence public sentiment on the matter. For good reason. This is one of those issues on which public opinion will in fact tell the story.

Health-care finance has all the ingredients to make it the setting for a decisive battle for what, almost two centuries ago, John Adams called the ``minds and hearts of the people.'' Unlike the North American Free Trade Agreement, which while important is complex and remote, health care touches each family deeply and immediately. Most people have well-formed views of our present system and know in general what changes they want and don't want. They won't be passive players in this debate.

But if the public is interested and bound to be engaged, its views are many-sided and, in important regards, conflicted. Some survey organizations have pressed their respondents to declare a simple up or down verdict on the current system, but most people know it too well to be fitted into such confining boxes.

The system has, in fact, enormous strengths and achievements, and substantial deficiencies, all of which are widely perceived. Large majorities of Americans receive better health care than any other people ever have, and they say so when queried about it. This part of the system isn't seen as broken.

But the costs of this system have been escalating at staggering rates over the past 15 years (though the increase was curbed the past year), and large numbers of people, even those with excellent coverage, have been left with a massive case of ``sticker shock.'' Cost escalation has fueled doubts and insecurities. What can people do if they are uninsured? Polls pick up these negative assessments of the system, just as they record the strengths.

Thus the public's judgment is not, as some have thought and others hoped, ``The system is broken.'' That would be a disturbing but politically unambiguous message. Rather, the view is more complex and demanding: ``It's a very good system, with some very big problems.''

Added to the conflict that inheres in this assessment is another, at least as profound, involving what to do about the problems. At issue here are the extent of government's role in a revamped system and how it is to be executed.

Americans say to government, ``Do something!'' But at the same time, a decisive majority of them say, ``Do something that - as it curbs price hikes and extends security - does not build a new governmental bureaucracy and does not hit me with layers of new costs, however labeled.''

All these sentiments define the boundaries within which the parties and the interest groups must conduct their struggles. These views are too strong to be ignored or somehow circumvented. This should have been evident from the outset, because the basic elements have been in place for years. Somehow, though, it wasn't evident to key players. The Bush administration acted as if it thought the public's call for action could go largely unheeded, and the Clinton administration acted in its first year as if the call was an invitation to push through a big, centralized, governmentally directed system of health-care finance.

Both administrations erred badly, leading to the curious political impasse that now prevails. For all the sound and fury of the health-care debate, and all the claims that have been made, no side today occupies the high ground.

The Republicans have done little to convince the big, unsettled middle of the public that they have both the will and the plan to meet the call for action. They continue to be seen as better than the Democrats in curbing government's growth, and whenever that response is enough they can win. But it's not enough here. A large majority really does want action to extend security in health-care finance.

The Clinton administration has convinced the decisive middle that it is committed to change, which by itself is a plus. But it has also at least tentatively convinced many people that its proposals for change lead in unwanted directions. The following assessments, from a Gallup survey done Oct. 28-30 for CNN and USA Today, shows this unambiguously.

Asked whether ``under President Clinton's health care plan, if it is passed,'' you would have more or fewer choices as to doctors and other aspects of medical care than at present, 42 percent of respondents said fewer, just 16 percent more, while 39 percent said they would expect to have about the same degree of choice. And 56 percent thought the ``total amount of money [they] pay for medical care'' would increase, just 14 percent that it would decrease, and 28 percent that it would remain about the same. Fifty-three percent responded that under the Clinton approach they thought ``there would be too much government involvement in [their] health care,'' just 8 percent too little, and 36 percent about the right amount.

As to whether they would be better or worse off under the Clinton plan, only 28 percent thought better off, 37 percent worse, and 31 percent that the plan would basically have no effect on them.

One year into the great debate, the public jury is still out. It still wants change in health-care finance. It still hasn't found a cure to which it will subscribe.