What Clinton could learn from the catastrophic health care catastrophe.

• Author: Monfils, Greg
• Position: President Bill Clinton, Medicare Catastrophic Coverage Act of 1988

Of the myriad health care plans being Fed-Exed and faxed to Bill Clinton's policy experts, the one that may serve them best has already failed: the 1988 Medicare Catastrophic Coverage Act. That's not because we need catastrophic care insurance any more than universal coverage, but because the catastrophic care bill's tortured collapse can provide the new administration with a road map of exactly what to avoid in tackling the tougher task of overhauling the entire health care system.

On the universal list of Good Ideas That Bombed, the catastrophic care act ranks near the top. Designed to protect elders from the financial and mental trauma of ever-growing medical fees, the bill was enacted by Congress and signed by President Reagan with grand expectations. But within a few months, it came under sure attack from geriatric rabble-rousers who believed they were getting a raw deal. The pressure worked: Congress, fearing the wrath of hoards of angry, politically active seniors, repealed the act, ending, for all practical purposes, the effort to provide seniors with security against the exorbitant costs of long-term or debilitating illness. In the years since, Congress and the executive branch, both badly burned by the episode, have made virtually no effort to revive catastrophic care.

The biggest losers in the fiasco were, of course, the nation's 31 million seniors. But there is a silver lining if we are smart enough to see it: The debacle shows us how to avoid the same mistakes in trying to create and pass legislation to fulfill another important reform, universal health care for all.

The lessons of catastrophic care legislation begin with how the bill failed. The story begins in 1986, when Republicans lost control of the Senate after the Reagan administration attempted to reduce cost-of-living adjustments on Social Security benefits. Chastened by the experience, Reagan and Republican congressional leaders moved to recapture the "compassion agenda" by extending an olive branch to the elderly.

Enter then-secretary of Health and Human Services Otis Bowen. Bowen's wife had spent the last three months of her life in a hospital with terminal bone cancer. That experience introduced him to the plight of many elderly couples who, although entitled to Medicare benefits, were often left destitute after a serious illness. Because Medicare automatically reduces payments after 60 days of hospital care and eliminates them entirely after 90 days, the only way elders were able to protect themselves financially in the event of long-term...