The Clinton Diagnosisrnby Thomas M. Wilsonrn•’•I. %,^•’;’..:• sj-arnj^ r ^ /It^MrnFor more than two decades, critics of the American healthrncare system have been unrelenting in their charge that it isrna singular failure and manifestly unfair. We are told that millionsrnof our fellow citizens have no access to basic medical servicesrnand that our very survival as a nation is threatened by therncosts of treating those who do receive care.rnIf this sounds a bit melodramatic or hyperbolic, listen to thernClinton diagnosis of what ails us. Before a joint session ofrnCongress last September, the President said, “Millions ofrnAmericans are just a pink slip away from losing their health insurance,rnand one serious illness away from losing all their savings.rnMillions more are locked into the jobs they have now justrnbecause they or someone in their family has been sick and theyrnhave a preexisting condition. And on any given day, over 37rnmillion Americans—most of them working people and their littlernchildren—have no health insurance at all.”rnPresident Clinton’s assessment of the cost of health care wasrnequally grim. He said we are now spending so much money onrnhealth care that large businesses are finding it difficult to competernglobally, small businesses are unable to invest, and evenrnour living standards are at stake. If health care costs continuernto “devour” the budget, Clinton told Congress, “Pretty soon allrnof you or the people who succeed you will be showing up herernand writing our checks for health care and interest on the debtrnand worrying about whether we’ve got enough defense, andrnthat will be it.”rnBy January, a grave situation had apparently deteriorated. InrnThomas M. Wilson is an assistant professor of political sciencernand public administration at Auburn University inrnMontgomery, Alabama.rnhis State of the Union Address, Clinton turned on those questioningrnthe severity of the crisis, saying: “Tell it to the 58 millionrnAmericans who have no coverage at all for some time eachrnyear. Tell it to the 81 million Americans with those preexistingrnconditions.” Even though he had upped the estimate of thernnumber of uninsured by some 21 million people only a year afterrnbecoming President and four months after saying it was 37rnmillion, hardly an eyebrow was raised.rnSince the Clinton prescription is based on his analysis of thernproblem, the accuracy of the latter is fundamental to the debate.rnUntil recently, few dissenting voices have been heard.rnRepublican leaders have never really questioned the allegedrnfacts or many of the underlying assumptions of the healthrncare policy “debate.” Consequently, they have been reducedrnlargely to putting forth their “alternative” plans, none of whichrnhas much appeal to the public and none of which has thernproverbial snowball’s chance in Congress. Who remembersrnthe Bush health care plan of 1992?rnThose who are able to define the health care “crisis,” explainrnits causes, and recommend a solution clearly have the advantagernfrom the outset. This is what Clinton has been able to do.rnBill Clinton and other advocates of compulsory national healthrninsurance have been very skillful in using statistics and “factoids”rnto support their case. Take, for example, the oft-repeatedrnclaim that there arc 37 million Americans without health carerninsurance who therefore have no “access” to the health care system.rnBoth components of this claim are misleading.rnThe figure of 37 million uninsured Americans is an estimaternmade by the Bureau of the Census. When the advocates of nationalrnhealth insurance use a figure of 37 million uninsured (orrneven 58 million), the impression they leave is that of a hugern24/CHRONICLESrnrnrn