Clinton's next quagmire is health care reform Foes to wage war for your opinion

August 09, 1993|By John Fairhall | John Fairhall,Washington Bureau

WASHINGTON -- The fight over the president's economic plan was light sparring compared with the punches that will be thrown over the next big issue on the president's agenda -- his long-awaited health care plan.

Originally due in May, the unfinished plan was put on ice while Congress dealt with the budget and deficit reduction. While that may have been necessary, the delay has cost the president momentum on health care reform and given critics an opportunity to organize opposition.

By the time he outlines the plan in a speech to Congress late next month, health industry groups will have laid a multimillion-dollar foundation for challenging key parts they don't like. Big budgets are being raised for advertising, lobbying and campaign contributions, the tools interest groups have used in the past to block reforms.

But industry groups won't be the only problem. Even though polls show the public wants some reforms, Americans have become more pessimistic about how the president's plan will affect their health care.

Nor is there consensus in Congress about how to proceed on health reform. Though regularly briefed on the plan's progress, lawmakers seem to have grown more cautious about what they'll support, especially if it is expensive. The budget battle has left Congress in an anti-tax mood.

It's no wonder that White House officials have set up what some call a "war room" to map a public relations campaign. The administration knows it faces a ferocious, protracted fight.

Mr. Clinton's plan would drastically alter the way medical care is delivered and financed, affecting all Americans and every aspect of the $930 billion health care business -- roughly 14 percent of the economy.

He will ask all employers to pay for insurance and will propose as much as $40 billion in new taxes so that government can pay for insurance for the unemployed. All Americans, regardless of their health or employment, would be guaranteed a package of benefits that includes preventive services, hospitalization, prescription drugs, some dental coverage and limited mental health treatment and long-term care.

While everyone is in favor of universal access to good health care, the president's plan faces opposition on many fronts -- foremost, the mandate on employers and new taxes. But there also will be fights over abortion coverage, which the president plans to include, a proposed national health budget intended to restrain spending, and creation of giant purchasing cooperatives that would buy insurance for consumers and regulate the health care marketplace in each state.

Opponents charge that the White House plan will undermine quality, limit patients' choices of doctors and bring about a system of governmentally rationed care. They and their congressional allies are ready to challenge any attempt to impose price controls on insurers, doctors, hospitals and prescription drugs.

Critics to spend millions

In fact, one organization calling itself Citizens Against Rationing Health has sprung up, boasting that it will spend $10 million on a "grass-roots media campaign" against the White House plan. The group is headed by Donald Devine, director of the Office of Personnel Management in the Reagan Administration and now a director of the American Conservative Union, and former Rep. Beau Boulter, a Texas Republican.

Asked why he believes the plan will result in rationing, Mr. Boulter says imposition of a national budget -- which would cap all health care spending at a certain level -- would lead to limits on care.

Among groups likely to support the administration, the AFL-CIO is expected to provide most of the financial muscle -- more than $3 million, but a fraction of what opponents can raise.

Consumer groups say they'll depend more on low-budget activities to rally support, like the 1,000 house parties that Families USA is planning soon after the president announces a plan in late September. The American Association of Retired Persons will spread the word to its 33 million members through its magazine and numerous community meetings.

But big, wealthy industry and professional groups also will engage in trench warfare, with the American Medical Association encouraging its 290,000 physicians to distribute literature to patients.

"The AMA plans to use extraordinary means to communicate with patients, physicians, the Congress and other decision-makers," says an internal AMA document. "Plans include patient materials, advertising, press conferences and releases, appearances on TV and radio, 'town hall' forums and a live teleconference."

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