President Clinton’s final budget is also his final attempt at a health care proposal that does something about the growing number of people who lack coverage. Though his plans spend a lot of money, they do little to solve the underlying problems in the nation’s health care system.

The president no doubt knows this, just as he knows that, politically, he cannot propose a comprehensive reform that gets at the reason so many people are losing coverage: rising costs. So instead he proposes spending more – more for the elderly and more for the young, more for the working poor and more for the nearly retired. He is offering more of the kind of programs that have had, at best, limited success. Despite all the medical access programs of the ’90s, the number of people without coverage has nearly doubled since he took office.

Consider his Medicare budget, which proposes to create a prescription drug plan for seniors. A program is necessary because of the high and rising prices of prescription drugs, even as the companies that make these drugs post record profits. But about the only way the president can expand Medicare without putting it on the road to bankruptcy is to underestimate Medicare reimbursement rates, putting hospitals, nursing homes and other health care institutions in jeopardy and shifting part of the cost onto patients with private insurance. That’s not a plan, it’s a shell game.

Rep. Tom Allen has been campaigning for a proposal that would have the government’s health care offices act like the same health maintenance organizations they have helped promote for the last seven years. His bill directs the government negotiate the price of drugs for Medicare clients, just as HMOs negotiate for their clients and just as the governments of other countries negotiate for their citizens. It is one measure that looks at one area of the health care industry and tries to find a cooperative solution to this essential service, and yet it has met resistance in Congress.

The president’s strategy of simply doing more might work if the economy keeps growing far out into the future, but would not work very well in a recession — especially if Vice President Gore takes office and keeps his word to focus on deficit reduction even in hard economic times. But even in the best of times, the president’s health care proposals — which total the ambitious sum of $305 billion over the next decade — leave the nation in relative terms where it was when he took office.

He is not solely to blame for this, of course. Congress helped plenty as it spent countless hours debating things like whether someone should be able to sue an HMO rather than focus on the fact that you can’t sue any insurer if you have no coverage. Short of catastrophe, President Clinton will hand his predecessor a strong economy, but he will also be leaving a health care system that continues to need major surgery.