Whatever the health plan, Clinton will call it victory



WASHINGTON -- When Sen. Edward M. Kennedy proposed some significant changes in President Clinton's health care reform plan the other day, the president replied that they were "a good place to start."

A couple of weeks ago Clinton was similarly receptive to some alternatives advanced by Senate Majority Leader George Mitchell. And the White House has taken pains to appear to be at least open to still another version being devised by a Republican, Sen. John Chafee of Rhode Island.

The message in all this is clear. Clinton is prepared to follow the advice a senator from Vermont, George Aiken, gave President Lyndon B. Johnson on the war in Vietnam: Simply withdraw and declare victory. In this case, the president obviously intends to declare victory and claim as his own whatever health care reform plan Congress passes.

There is no mystery about the political calculus. Clinton has put so much personal capital behind health care reform that he needs a success to regain his momentum and to enjoy the power to set the national agenda in the final two years of his term. If he were to lose on health care, the president would enter his campaign for re-election -- it starts immediately after the 1994 elections -- clearly on the defensive.

But Clinton can influence the decision on health care reform only at the margins. The campaign against his proposals has been effective enough so that polls find a clear plurality against them, although there is majority support for many significant changes in the health care system. And the president himself has been thrown off stride repeatedly by issues as diverse as Haiti and Paula Jones, Bosnia and Whitewater.

Timing is also important. The consensus among political strategists is that there is a far better chance to pass a health bill this year than there will be after the elections. They are operating on the theory that most members of Congress would be reluctant to go before their constituents having voted against any changes in the health care system -- and thus adding even more weight to pervasive suspicions in the electorate about the inability of the government to perform.

From the White House point of view, the ideal result would be action sometime before the congressional recess in August. Such timing would allow the president to campaign for Democrats as a triumphant leader in September and October.

But the history of congressional handling of such complex issues is that final decisions are rarely made until they have to be made at the last possible moment. So no one would be surprised if health care were not resolved until sometime in late September when incumbents will have one eye on their campaigns.

The changes proposed by Kennedy replace the mandatory state health alliances with voluntary cooperatives to buy health insurance. They also soften the employer mandate on small business that has evoked the greatest hostility.

But the critical factor is whether his plan -- or others advanced by Mitchell or Chafee or several different members of the House -- would meet Clinton's bottom-line requirement for universal coverage. Or, put another way, what is Clinton willing to define as universal coverage?

The problem with this requirement is the transitional costs of covering those who would not be reached routinely through their jobs. The administration has insisted all along that health care reform can produce huge long-term savings, and there is considerable supporting evidence to suggest that that is true. But at the outset, the costs of covering everyone inevitably will mean either taxes or higher insurance premiums, and that is a hard sell with senators and congressmen already uneasy about their prospects in November.

Thus, the prospect is some compromise that provides for universal coverage to be phased in over several years. The same formula might be applied to the benefits package to achieve comprehensive coverage.

Clinton has not yet sent any clear signals on what he would accept. Commenting on Kennedy's plan, the president warned against allowing employers to get "off the hook altogether" in deciding on a financing plan.

But the issue is largely out of the control of the White House now, and Clinton has little leverage when there are so many reservations about his plan. So in the end he will follow George Aiken's advice from another time and simply declare victory.

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