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More everything from Washington - reflections on President Clinton's health care proposals - On the Right - Column
NEW YORK, JANUARY 9
WASHINGTON, D.C. January 6, 2000. President Clinton announced today his plan for a federal program to take care of the special health needs of Americans 45 to 55 years old. "There are twenty million Americans out there during the most demanding years of their economic lives who need medical care and can't afford to get it. Those are the mothers and fathers who are struggling to pay the college bills for their children, to meet their mortgage payments, many facing layoffs, many uninsured or insufficiently insured." The category Mr. Clinton has in mind to help with his new Medicare bill is known by insurance statisticians as the "near near elderly." The problems of the "near elderly" were coped with by the Administration's Medicare Expansion Bill of 1998 . . .
Several things were predictable. The first, that with the faintest whiff of a "surplus," ideas would bombard the Clinton Administration on how to spend that surplus. The second, that the philosophical disarray of the Republican opposition is such that the current proposal actually hit the ground running. Early reports of "moderate" Republican reaction are that indeed there is reluctance to expand Medicare, but, to quote Laurie McGinley of the Wall Street Journal, "many Republicans may find it hard to attack an election-year valentine for older Americans, who typically vote at higher rates than their younger counterparts."
Prescriptive learning ("sanctioned or authorized by long-standing custom or usage") is the means by which a mature political community governs itself, applying reason and experience. There are two models by which we are instructed. The first advises us: Let things stand if experience confirms that they have proved satisfactory. The other is the sunset-legislation approach: Many laws are enacted and sit around years later for no better reason than that to repeal them would put people out of work. Some years ago the exciting proposal was made by Sen. Charles Percy and others to apply sunset laws to all regulatory federal agencies and programs: Ten years after they came into being, they would be eliminated unless relicensed, after examination of need and performance, by Congress.
The congressional decision in 1994 was to oppose the Clinton plan to turn medical care over to the public sector. That decision was ratified by the Republican landslide in November of that year. On the basis of that event, and what had come before, we should have arrived at the profound decision that we should not intrude government into medicine any further -- prescriptive wisdom. The President now proposes to enlarge the scope of Medicare even though projections establish that Medicare is a loose cannon.
Practically at the same moment, President Clinton announced a program for child care, a $21-billion package which proposes not merely nannies/observers to look after the tots during working hours, but whole pedagogical theme parks by which to accelerate the learning experience.
The idea of Washington, D.C., addressing the problem of child care is an arrant misapplication of form and priorities. The child-care problem is so varied as to cry out for individuation. The problem in Staten Island is very different from the problem in the Bronx. Even so, the municipality of New York needs to address the problems. The child-care problem in Davenport, Iowa, has some things in common with, but others distinctive from, the problem in Ogden, Utah. The political principle of subsidiarity ordains that a higher government echelon should not address a problem that can be addressed by a lower echelon, and the Ninth and Tenth Amendments to the Constitution make the same point. Child care is the model of a social problem that cries out for local fine-tuning to address appropriately. The only thing the Federal Government can do is to distribute money. But that money comes in from the same sources that are there to finance social programs with a sense of local needs and priorities.
The fusillades from Mr. Clinton, proposing the progressive annexation of more age groups for his infirm Medicare program and suggesting that child care is a problem best handled by the Federal Government, leaves the observer with the demoralizing sense that maybe nothing is ever truly learned. How exhilarating if the Republicans who control the Congress were to reply to the President that, thanks very much, we don't need to go back and re-do kindergarten.