It’s not just health care that bedevils the Clinton administration. It’s also the Clinton administration that bedevils health care. And occasionally it has the connivance of congressional Republicans.

Kid Care is a case in point. This health care program for children is based on a census showing that 10 million children lack private health insurance or Medicaid. From that, the bipartisan proponents of Kid Care assumed that these 10 million uninsured kids must belong to families that have too little income for the one and too much for the other. So they resolved to spend $24 billion over five years - provided by an increase in the federal cigarette tax - to remedy the "problem."

But more careful analysis of census data shows that most of those 10 million children don’t lack health insurance all the time. Many lose it briefly as their parents change jobs, then regain it. The families of many uninsured children have incomes well above the poverty level but choose not to invest in health care for their kids. Many more are eligible for Medicaid but are not enrolled.

Certainly, children should be insured. But the better way would be to offer low-income families a subsidy, possibly through a tax credit, for private insurance premiums. Why? Because government-based health insurance, like Medicaid, can cost five times the premium for private children’s policies. And because government-based health insurance will, by conservative government estimates, invite families capable of paying part or all of the premium for private coverage to switch to government insurance paid entirely by taxpayers.

Yet by increasing the federal match for enrolling children in Medicaid, the Clinton administration is encouraging states to enroll children in this government plan rather than subsidize private policies for them.

And now, having taken one stealthy step foward government-run universal health care, the White House proposes another: including some 3 million uninsured "near elderly" – 55- to 64-year-olds –  in Medicare. More than 85 percent of the 18 million Americans in this age group have health insurance, at premiums of about $5,000 a year. The 13.4 percent who don’t are, reportedly, older workers who have been laid off, or who retired early without insurance, or who are unhealthy, or who otherwise do not have private health insurance and don’t qualify for Medicaid.

Surely, some of the near-elderly will find other jobs that afford them health insurance. But just as surely, fewer will do so if Medicare kicks in, relieving both employers and employees of most health-insurance costs. Yet how will Medicare pay?

This government health insurance program is projected to go broke by 2007 from covering care for the 38 million recipients age 65 and over, regardless of financial need. How will Medicare cover – and how well could it cover – today’s 3 million uninsured near-elderly? Worse, how will it cover  the uninsured among the 30 million baby boomers who will reach "near-elderly" status by 2005?

The White House has suggested allowing the near-elderly to swap early Medicare benefits for lower Social Security benefits at age 65. But Social Security also faces financial problems. And ensuring a battle of competing entitlements later doesn’t pay for a new entitlement for the near-elderly now.

Another entitlement by dint of age and stage, more federal regulation, more federal expense are not the way to go. Creative policy-making – expansion of medical savings accounts, for example – that emphasizes personal responsibility for health and health insurance and incentives to accept that responsibility – is the way to go. It’s not, unfortunately, where this White House is headed.