Leaks, trial balloons ease way on health care ON POLITICS



WASHINGTON -- The White House has been following a time-honored political strategy in trying to prepare the Congress and the voters for President Clinton's official unveiling of his program for reforming the health care system.

For almost two weeks now there have been daily leaks of particulars of the plan to the press. At the same time, the White House has broadened the circle of those being briefed, thus assuring even wider discussion of the particulars among reporters, politicians and lobbyists.

This is a classic use of the trial balloon because all of the elements disclosed so far have been put forward as tentative decisions subject to amendment when the president finally approves. The theory is that Clinton has retained the freedom to make changes without appearing to have backed down to pressure from the opposition. Clinton himself has brushed aside questions with repeated suggestions that there are many changes possible between now and Sept. 22, when he is scheduled to address a joint session of Congress.

At the same time, the strategy has allowed the administration to identify the sources of political trouble ahead -- both in terms of the particular aspects of the plan and particular factions in the political equation. Thus, for example, the White House has learned in the last few days that the idea of doing much of the financing by cutting back sharply on federal spending on Medicare and Medicaid programs may be a pipe dream.

But all the political maneuvering cannot alter the basic problems that Clinton faces in trying to reform the health care system.

The first, and most obvious, is how to meet the costs of extending coverage to all Americans. The sensitivity to higher taxes is so great at the moment that even Clinton's most loyal allies on the health care issue doubt they can win approval for anything beyond higher taxes on cigarettes and liquor, the so-called sin taxes.

Indeed, the cost issue is so sensitive that the trial balloons have been deliberately rather vague on the question except for the suggestion there were these large savings to be made on Medicare and Medicaid. The hints of a payroll tax on business to cover insurance costs have evoked totally predictable howls of protest, even from some business groups that generally favor reform and stand to gain from it.

Second, it has become increasingly clear that there will be strong resistance to mandating health insurance coverage for employees of small businesses. Such a provision is essential to achieving the basic goal of universal coverage, but small business is a powerful political force with both Democrats and Republicans in Congress. And the argument that the small businesses are the ones providing most of the new jobs being created by the economy is a persuasive one.

The administration has used the trial balloons to defuse some of the issues that might have been expected to engender the most heated opposition. The leaks have made it clear, for example, that there will be tight restrictions on the coverage for mental illness and on dental care. The White House briefers also have made it plain that the plan will allow Americans to continue to choose their own physicians.

The sheer number of issues already covered by the leaks is large enough to demonstrate how complex the legislation will be -- and how difficult it will be to reconcile dozens of factions with special concerns. Nor do all the problems arise from the predictable critics with peculiar interests to protect. When the White House floated the idea of using huge cutbacks in Medicare and Medicaid, for example, the practical political questions were raised by the leading House expert on health care issues and a strong advocate of reform, Rep. Henry Waxman, D-Calif.

Clinton and his advisers have known all along that the health care problem was vexing, complex and not subject to easy or painless solution. That is one of the reasons Hillary Rodham Clinton was assigned to head the task force -- to send the message that this was an issue with the highest priority.

But recognizing the importance of the problem and finding a formula to solve it that can win broad support are two different things, as the White House is discovering with its campaign of trial balloons.

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