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IT IS NO SMALL IRONY that almost four years to the day that President Clinton unveiled his overly ambitious health care reform plan-only to have it later collapse in flames-the president now is following a very different strategy for reform.
While President Clinton says his overall goal of achieving universal health care coverage has not changed, how he will accomplish that objective has.
Health care reform, he says, will be achieved one step at a time. This is a common-sense idea he once foolishly discarded but that he has since wisely embraced.
We couldn't agree more with the president when he says, "We've got to do it right so we can go on to the next step."
Certainly, that incremental approach is the only way to go where even the smallest mistake or miscalculation in a trillion-dollar health care system can wreak horrendous damage, an obvious point but one the administration didn't grasp when it launched its ill-fated crusade for sweeping health care reform in 1993.
Since the collapse of its overreaching plan, the administration has stuck to its one-step-at-a-time-approach to reform with impressive results.
Last year, the administration threw its support behind legislation curbing pre-existing medical condition exclusions, a move that gave a jump start to a languishing measure. Without administration support, that vital piece of health care legislation could well have died.
The Clinton administration's role in advancing health care reform a step at a time also has been evident this year. It helped move legislation opening up Medicare to competition, which will give retirees more choices and save money for the government, retirees and employers.
While the administration's approach is correct, this isn't to say all of its proposals are on the right track.
We are concerned, for example, about President Clinton's suggestion that something needs to be done to assure health care coverage for employees who retire before 65 and are not yet eligible for Medicare.
We are not clear on what exactly the administration has in mind. Given Medicare's still-shaky financial position, surely it cannot afford to also take on the health care burden of early retirees, putting aside whether individuals should be encouraged to retire at such a young age.
And if the administration is suggesting that employers' health care obligations under COBRA-now limited to three years-be expanded to a 10-year responsibility, we think that would cause more harm than good. Expanding COBRA liability would discourage employers, especially smaller companies, from offering any health care coverage.
Other immediate reform objectives make more sense, such as banning so-called gag rules that prevent providers from discussing such things as alternative treatment costs and options.
We think that by approaching health care reform on a step-by-step basis, the White House is clearly on the right track. Even if some of those steps turn out to be false ones, the administration appears far more likely to achieve reasonable and desirable goals this way than by taking a flying leap into oblivion as it did with its over-reaching health care reform plan only a few years ago.