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. …