Back in 1991-92, the anger building across the country produced a pattern of middle-class political radicalization that reached from David Duke to Ross Perot - and to Bill Clinton, if you listened to his campaign promises. Now, the middle class is facing a new round of economic pressures. You have to wonder how much longer they're going to sit and take it.
Hollywood made movies about 1930s hardships, so why not about these? Instead of "The Grapes of Wrath" set in the central valley, we could have the frozen pizzas of wrath set in Ventura County. Health-care reform will be an interesting test, because notwithstanding all the hoopla coming from the Clinton administration, the two most salient facts about how it's going to be paid for are these: Clinton doesn't want to give us the numbers or the financial details, and the middle class knows this and isn't buying his package as yet.
Ah, but, you'll say, about 50 percent to 57 percent of the public backs the Clinton plan or has hopes for it. True, but the enthusiasm is strongest among lower-income groups, and the best evidence is that middle-class support is only in the 35 percent to 45 percent range. The average American who now has health coverage is skeptical - and ought to be. People who don't have coverage (or have inadequate coverage) will gain, and their gain will probably involve a loss - in dollars, quality of care or choice of care - by the bulk of the middle class now insured and reasonably content.
Admittedly, that's not what the trumpeters of Clintonland are currently insisting, but if you don't want to figure out the truth from the missing numbers, then you can also make a pretty good estimate by looking at what is happening in the rest of the industrialized West. There's a growing realization that countries can no longer afford the expensive welfare-state programs. From Canada and Australia to Britain, Germany and Scandinavia, the economies of health care are boiling down to a few painful words: We can't afford what we thought we could.
Cutbacks and painful decisions are everywhere. Government after government finds health care a losing issue because somebody's gain is somebody else's loss. In Germany, politics is being churned by debate on how to finance the costs of home nursing care for the elderly and handicapped. High-powered health issues in British politics this year have included talk about charging pensioners and children for now-free prescription drugs, as well as ending free health care for those who can afford to pay.
In Canada, where high national health insurance outlays are consuming the budgets of the various provinces, Prime Minister Kim Campbell provoked a storm of criticism for saying that user fees might be imposed on care that is now free. In fact, it is hard to see any major Western nations where health care and cost issues are helping the incumbent government.
The same problem is developing here. To put tens of millions of new Americans on the health-insurance rolls, taxes and costs will rise for the great bulk of middle-class Americans now covered. For all but the few who can afford high charges to go outside the system, the quality and choice of care will probably deteriorate because there is already a shortage of primary-care physicians. Waiting rooms are likely to be as crowded as rush-hour buses. …