Health Care Crossroads

October 26, 1993

President Clinton's crusade to overhaul the nation's $900-billion-a-year health care system reaches another crossroads tomorrow when he sends one of the most sweeping legislative proposals in the nation's history to Capitol Hill. Once it arrives, perhaps 3,000 pages thick, it will become the obsession of the 103rd Congress until it finally adjourns to face the voters in November 1994.

Washington lawmakers are well aware the president has already accomplished one of his major aims: Health care reform is front and center on the nation's political agenda. Whether a politician is for or against or off on a tangent in regard to the Clinton plan, it could be the kiss of death to oppose some kind of fundamental change. The question -- the key question -- is what kind of change.

No one in the administration even pretends the intensive task force study supervised by First Lady Hillary Rodman Clinton has come up with final answers. Already more than half a dozen alternatives are in the hopper and friends as well as foes of the Clinton plan have a host of pet ideas, complaints, special pleadings and palliatives to offer.

What finally emerges, however, will probably conform in principle to some key White House objectives: Universal coverage for all Americans, sufficient government controls to curb the runaway costs of health care and enough flexibility to allow states (and individuals) some modicum of choice.

In the runup to tomorrow's unveiling, the White House got a reminder of the difficulties it faces when the American Association of Retired Persons, a supposed ally, publicly deplored the prospect that Medicare recipients might get a less-generous package of benefits than younger citizens who are folded into the administration's proposed managed-competition system. Yet the AARP opposed having the elderly included in the new system.

Then there came warnings from Senate liberals that suggested health alliances, financed by the payroll contributions of employers and employees, could be monopolist in their bargaining with health care providers and insurers.

With such friends, the Clintons might not need enemies. But they will have plenty, starting with doctors concerned about incomes, hospitals concerned about profits, small businesses concerned about survival and insurance and pharmaceutical corporations that foresee only adversity.

Nevertheless, Mr. Clinton's first great success as an agenda-setter may be seen in the saga of a critic, Jerald R. Schenken, an Omaha physician and a Republican, who ran for the House in 1988 by stressing the budget-breaking trends in health care and won only a yawn. This time he is running for the Senate and will have no trouble gaining attention for his favorite issue, thanks to the bully pulpit of a Democratic president.

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