Republicans seek to join health care movement ON POLITICS



WASHINGTON - - It wasn't too long ago that any talk of governmental involvement in health care would send Republicans screaming "socialized medicine." That favored GOP bugaboo, having failed to shoot down Social Security when it was launched by Franklin D. Roosevelt in 1935 or to block its numerous revisions and expansions since then, later was applied against proposals for national health insurance -- and still is, in some of the most conservative quarters.

Sen. Phil Gramm of Texas said in New Hampshire the other day that the Clinton administration's expected approach would "federalize the system and place the process of making medical decisions in the hands of . . . federal bureaucrats." Gramm suggests some of his fellow Republicans need "a reality check" on what a country already being "bankrupted" by the Medicare and Medicaid systems can afford to do.

But Gramm's remarks on the subject sound increasingly lonely, as other Republicans in Congress, seeing the train leaving the station, rush to climb aboard with alternatives. The old scare tactics conjuring up images of faceless bureaucrats writing prescriptions and quack doctors being foisted on hapless patients aren't cutting it anymore.

Instead, leading Republicans in Congress are facing the prospect that public concern over the cost of health insurance and its present unavailability to 37 million Americans is going to be a major issue when they are obliged to face the voters again next year. They want to demonstrate that they understand the concern and want to do something about it.

As a result, the solidarity shown by the Republicans against the Clinton budget-reduction package, or the obstruction as the Democrats would say, is nowhere present as Congress prepares to deal with the Clinton health-care package. And while the House and Senate Republican alternatives are a far cry from the sort of universal insurance coverage the president is poised to propose next week, they constitute a serious effort to be part of the dialogue from which the eventual legislation will emerge.

Some of the GOP proposals are clearly beyond compromise in clinging to traditional party positions. The Clinton plan would require employers to provide coverage; the chief Republican plans would merely oblige them to make health insurance available for employees to buy themselves, and hence would be far from universal. One plan would "require" employees to have some insurance plan or face a tax penalty -- a scheme of questionable enforceability.

At the core of the Republican approaches is a willingness to tinker with the existing system, rather than undertake a major overhaul as in the Clinton approach. In keeping with the GOP bottom line against new taxes, the House Republicans argue that savings needed could be achieved in the existing Medicare program and through changes in the federal retirement system.

Still, the old Republican stonewalling against "socialized medicine" has all but crumbled. Even Gramm says he favors legislation facilitating catastrophic coverage and making sure employees don't lose their coverage when they lose or change jobs. He also backs creating "medical IRAs" through which individuals could save for paying medical expenses.

Sen. Ted Kennedy, long in the forefront of the Democratic drive for national health insurance, says the Senate Republican alternative offered by Sen. John Chafee indicates to him that the Republicans "want to be a part of the solution."

Clinton, in also welcoming the Republicans' alternatives, may be thinking of how shutting them out of the deficit-reduction formulations contributed to the stonewall they erected against his plan.

And the Republicans themselves may be worried about the image of obstructionism they earned as result of their lock-step opposition on that vote.

In any event, the seeming stampede among many Republicans to get aboard health-care reform at the takeoff, rather than throwing their bodies across the runway to abort it, augurs well for the chances of significant changes over the next year -- though with much political as well as substantive pulling and hauling along the way.

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