WASHINGTON -- Last week, Rep. Dan Crane voiced a worry that lurks at the back of most lawmakers' minds as they move slowly and painfully toward legislation to reform the U.S. health care system.
On Wednesday, Crane, R-Ill,, and his colleagues on the House Ways and Means Committee were holding their first drafting session on the health care bill. No legislation was written that day, but there was a lot of preliminary speechifying.
Crane urged fellow legislators not to repeat the disastrous course they took six years ago when they passed the so-called "catastrophic" bill, and were later forced by public pressure to repeal it.
To understand Crane's point you need to go back in time and examine just what happened in 1988 that to this day to spooks legislators.
At the time, Congress decided to expand Medicare, the federal health insurance program for the elderly, so that senior citizens could receive long-term "catastrophic" coverage for a chronic illness or for an extended stay in a nursing home. To help pay for the coverage, lawmakers approved a surtax on the upper-income elderly.
But Congress misjudged the mood of the senior electorate. They didn't feel the additional coverage was worth the price the would have to pay, and they vehemently opposed the change.
The most vivid display of geriatric anger occurred in Chicago, a few months after the bill was passed, when Ways and Means Chairman Dan Rostenkowski, D-Ill., was ambushed by a small, vociferous group of elderly constituents. The placard-waving seniors descended on his car, pounding on it and shouting epithets.
Other congressmen faced similar outbursts when they went back to their home districts after the 1988 congressional session. They got the message. Congress returned the next year to axe catastrophic coverage and the accompanying surtax.
Rostenkowski and others said at the time that they were frustrated because they truly believed in the catastrophic health bill, but they weren't going to ignore their constituents' wishes.
Fast-forward to 1994. Lawmakers know they will be reaching into the lives of nearly every American in revamping the way people choose their doctors and pay for services. Make a mistake, ignore the mood of the electorate, and the reaction will be no less vehement than it was in 1988.
But what does the public want? With the catastrophic health bill, legislators at least thought they knew. This time, they don't seem to h ave a clue, and the events of six years ago are making them tentative and wary.
Members of Congress could not have been encouraged by Monday's edition of The Washington Post. The paper carried a poll showing that fully half of those surveyed disapprove of President Clinton's plan for creating health alliances that would coordinate insurance coverage and payment.
But the poll didn't say what the electorate would replace the Clinton plan with. A slightly modified version? A radically different system? Nationalized medicine, modeled on the Canadian approach? It's hard to tell.
Enter Rostenkowski, who must still remember what it was like when his constituents chased him out of a parking lot. The Ways and Means chairman, who usually likes to craft bills behind closed doors, is opting for government in the sunshine this time around.
"It is important for me that each of you have an opportunity to express your views," Rostenkowski told his committee members as he began Wednesday's meeting with an unusual open session.
In his preliminary private meetings last month with committee members, Rostenkowski discovered no strong core of support for any of the reform alternatives. So now, before the committee members vote, he's going to throw open the floor and let them jaw about the different proposals for the next two weeks.
Part of Rostenkowski's motivation may be to get the member's constituents indirectly involved in the debate. In explaining why he scheduled these freewheeling sessions, Rostenkowski said he believes that "education of ourselves and the American people is an important part of our job."
Maybe Rostenkowski is hoping that when average Americans hear something they like from the debates, they will let their representatives know -- thus avoiding another "catastrophic" mistake.
