WASHINGTON -- Hillary Clinton will need all of her lawyerly skills as she tries to forge a consensus on health care reform, an issue on which special interests and their congressional allies have blocked change for years.
Recognizing the obstacles posed by interest groups and the sheer complexity of the issue, Mr. Clinton yesterday named his closest adviser -- his wife -- as the unpaid head of a health care task force. Mrs. Clinton, an attorney, served in a similar position in 1983 by helping her husband, then governor of Arkansas, buck teachers and other interests to pass school reform legislation.
"Of all the people I've ever worked with in my life, she's better at organizing and leading people from a complex beginning to a certain end than anybody I've ever met in my life," Mr. Clinton said of his wife.
"In the months ahead, powerful lobbies and special interests will attempt to derail our efforts. We may make those people angry, but we are determined to come up with the best possible solution for America," he said.
Mr. Clinton decided to put his wife in charge of health care reform after his transition advisers warned him of the high cost of giving all Americans access to health care. The president rejected their conclusion that universal access would require drastic price controls and probably tax increases as well.
Reform-minded lawmakers applauded her appointment, which Clinton aides first revealed last week, hoping she can the unite the administration and tame opponents.
Capitol Hill sources say she should be able to quell turf battles among Clinton aides on the health issue. Domestic policy adviser Carol Rasco, senior policy adviser Ira Magaziner and Health and Human Services Secretary Donna E. Shalala all have sought jurisdiction.
"By putting Hillary in there, you're able to end all that," said a congressional aide involved in health reform. The question is whether she can overcome the special interest pressures. Physicians, insurance companies, pharmaceutical manufacturers and other health industry groups have bought a place at the reform table by spending lavishly on the presidential and congressional races in 1992. The American Medical Association alone spent $2.7 million to gain a say over legislation.
"Why hasn't health care, any sort of national health care proposal, come before Congress up to this point?" asked Josh Goldstein of the Center for Responsive Politics, which studies the impact of money on politics. "Not only does the money get access and influence, and get pieces of legislation for the contributions, it can also be something that suppresses pieces of legislation."
Using the latest computerized data available from the Federal Election Commission, the center calculated that as of last summer the health industry had contributed nearly $14 million to congressional candidates, the Democratic and Republican parties, and the primary campaigns of Mr. Clinton and former President George Bush.
Health professionals, mainly physicians, led the way with $7 million in individual and political action committee contributions. Manufacturers of drugs and health products gave $4 million, while hospitals and nursing homes were the next largest donors, with a total of $1.8 million. The rest of the money came from other health care providers.
In addition to the health industry, the insurance industry chipped in another $10 million.
Much of the health and insurance money given to congressional candidates goes to lawmakers serving on committees with authority over health care issues, among them the House Ways and Means and Energy and Commerce committees, and the Senate Finance and Labor and Human Resources panels.
AMA executive vice president Dr. James S. Todd said the group's PAC contributions are intended to gain for its eight full-time lobbyists access to lawmakers. "I don't think you can buy a congressman heart and soul for $5,000, $10,000. I think what you buy is the ability to get into his office and talk to them."
What the AMA and other health industry groups want this year is as varied as the groups themselves.
As a result, each group has put forth a reform plan, in each case seeking to preserve its own power:
* Insurers want to maintain the insurance system. To guarantee universal coverage, the Health Insurance Association of America's plan would offer unspecified tax incentives to employers to provide coverage for all workers. To hold down costs, the insurers recommend that the government limit tax-free health benefits, requiring workers to pay taxes on benefits that exceed a minimum package.
* Doctors want to reform the insurance industry by requiring it to insure all people regardless of risk, while maintaining the right of patients to choose their physicians. To help control costs, the American Medical Association would reduce liability premiums that physicians pay and pass them on to patients in the form of higher bills and what critics call unnecessary tests.