May 12, 2000 -- You'd think that a president, after seven and a half years in office, would know better. But President Clinton recently made statements that will assure that he won't be able to include any major health care legislation among his administration's list of accomplishments.
The president twice last month publicly called on Congress to pass Medicare reform and the patients' bill of rights, the two most perpetually controversial pieces of health care legislation. For example, he used a recent radio address to tell Congress that these two legislative initiatives should be its top priority for its remaining 75 legislative days of 2000.
Clinton's statements virtually guaranteed exactly the opposite. By making health care reform such an important element in his own personal political agenda in this election year, Clinton assured that the Republican Congress will not pass any such legislation. Simple reason: no Republican wants to help Clinton enhance his legacy.
I predicted months ago that no substantive health care legislation would pass in 2000. Health care reform is too political an issue for Congress to handle during an election year, especially when the White House is held by one party, the Democrats, and the Congress by the other, the Republicans.
Clinton could have taken two routes in this, his last year in office. He could have tried to rise above partisan politics and offer to share the credit with the Republicans for the enactment of health care legislation. He could have sought compromise on the legislation so that Republicans as well as Democrats could take credit.
Instead, he chose to be political. He decided to push his own partisan agenda and, if successful, take credit for the Democrats. Clinton thus assured that the Republican Congress will also act politically - and as everyone in Washington knows, partisan politics causes nothing other than grand rhetoric and frustrating gridlock. That's what will happen now.
Just last week, several dozen Democratic senators appeared with the president to introduce a bill similar to the drug proposal that Clinton first proposed last year. House Democrats are expected to follow suit. The health subcommittee of the House Ways and Means Committee held a hearing to discuss this prescription drug proposal that same week, but nothing concrete was decided.
If you're interested in a solid patients' bill of rights bill, which will help you if you choose to fight your HMO, or if you're interested in coverage for outpatient prescription drugs under Medicare, you'll have to wait until next year, or later. Next year, there are no federal elections. Congress will be more receptive to changes.
However, even next year enactment won't be easy. There remain very fundamental philosophical differences between the Democrats and the Republicans over how to achieve these objectives. It really comes down to what role the federal government should play and what role the private sector should have.
One example: The Democrats supporting Medicare coverage of outpatient drugs believe that the federal government should run the reimbursement system, just as it does now. This would put enormous power and leverage in the hands of federal bureaucrats but would enable the government to control prices and assure equity.
The Republicans supporting outpatient prescription drug coverage want it administered through existing private insurance plans. They argue that about two-thirds of the elderly now have some prescription drug coverage, and the coverage can be extended to all seniors by providing federal dollars. They argue that not everyone needs the same coverage and therefore not everyone should be required to pay for it.
The only way that legislation can be enacted next year or in subsequent years is if a compromise can be reached between these two very different views of the role of government.
For this year, the prognosis seems clear: Given this year's elections, there is no way that such differences can be reconciled in 75 legislative days. It is becoming more evident that President Clinton will have to look elsewhere for his legacy.
Wayne Pines, WebMD's Washington columnist, is a former Associate Commissioner and Chief Spokesman of the Food and Drug Administration. The opinions expressed in this article are not necessarily those of WebMD.