A futile pursuit

Our last two Democratic presidents have wasted a year each by pursuing the perceived moral imperative of comprehensive health care reform aimed at universal insurance.

It is fashionable to blame tactical misplays.

Hillary Clinton erred, you see, by concentrating policymaking in secret executive branch sessions.

Barack Obama erred by tactical overcompensation, you see, embracing only principles and leaving the complex detail to the negotiations of Harry Reid, Nancy Pelosi and Max Baucus, Mary Landrieu and Ben Nelson.

Meantime, every poll I see shows two things. One is that Americans believe our system of health care needs cost-containment and more efficient and widespread insurance coverage. The other is that Americans are speaking only generally because, truth be known, they're not all that personally unhappy with the insurance they have or the medical care they receive.

Stanley Greenberg, a leading Democratic pollster who surveyed political attitudes for Bill Clinton, could have told Democrats where they were mistaken. He wrote months ago that health care reform would come down to what it means for, or to, the person insured now.

It may be time -- in fact, I rather suspect it clearly is time -- for Democrats to acknowledge that the American people do not view a major centralized overhaul of health care aimed at universal insurance coverage as the imperative Democrats seem to assume.

It is time to acknowledge that people, while clearly seeing some changes we need, will inevitably come to view a comprehensive and centralized remaking of the health care system in some massive singular measure as an unknown to be feared.

It is time to acknowledge that the way to go on health care reform is to identify individual elements of our system that need fixes and address those individually with shorter, simpler, more comprehensible, more compelling measures that can be considered less emotionally and more objectively.

To remake the whole system in a massive measure being negotiated in congressional offices with ever-amended complexity gives you this: Democrats standing in town hall meetings trying to defend something they can't get hold of against fear of the unknown.

In American political dialogue, fear will always overpower the complex policy detail of a privately negotiated amendment on Page 420 of one of six vast, comprehensive health care reform bills inching their way through multiple House and Senate committees.

If the ever-rising cost of Medicare is the problem, then let's break that out and get hold of it. Maybe we could let Medicare negotiate drug prices. Maybe we could let Americans buy re-imported drugs.

A lot can be addressed administratively without the political heartache. Cardiologists and some other specialists are saying that administrative cuts in their reimbursements for referrals under Medicare threaten their very existence. They may all have to become salaried hospital employees, one was telling me.

Overstated or not, that's a major cost-cutting initiative in Medicare with potential implications for the broader health care system that no politician voted on.

Portability? That ought to be easy to pass. Pre-existing conditions? A person who loses insurance at no fault to himself and then buys another policy that won't cover the illness he brings -- that needs changing, and the political will to change it would be strong.

But some vigorous youngster rolling the dice without insurance -- his protection against denial of a pre-existing condition ought to be paired with a specific discussion about whether he ought to mandated to get health insurance just as he is mandated to insure his car.

If we broke out the individual elements of major health care reform, we might surprise ourselves. We might achieve something close to universality without even knowing we were doing it. And that's probably the only way we can accomplish it.

John Brummett is an award-winning columnist for the Arkansas News Bureau in Little Rock and author of "High Wire," a book about Bill Clinton's first year as president. His e-mail address is jbrummett@ arkansasnews.com.