Beady Budget Eyes on Health Care

May 15, 1994

Straight talk on health care reform comes most convincingly these days from the non-partisan Congressional Budget Office and its very candid director, Robert Reischauer. As half a dozen congressional committees scratch up alternatives to President Clinton's elaborate proposal and lobbyists besiege Capitol Hill, the CBO sharpens its pencils, lowers its green eyeshades and offers analyses that all sides watch with hopeful trepidation.

Mr. Reischauer's latest pronouncement puts calculators and spread sheets to the side and delivers a sound lecture on legislating. He worries that as various committees work over the administration plan, they might come up with something that looks good on paper (and sells politically) but would be impossible to implement. Health care reform, he suggests, "has to be an integrated whole."

These words must sound like sweet reason to the president and his first lady as they find themselves unexpectedly on the defensive during the crucial committee-markup stage of the health care struggle. But Mr. Reischauer is not in anyone's corner, nor can his support be taken for granted.

In February, he torpedoed administration efforts to treat health care financing as something that had nothing to do with the federal budget. He called it "a federal entitlement" based on "mandatory payments" that "represent an exercise of sovereign power." Although Mr. Reischauer's agency did not utter the T-word, its comment confirmed that mandatory payments would amount to a TAX.

It was at this point that White House momentum wilted, with the CBO estimating the administration plan would enlarge the deficit by $74 billion over five years instead of shrinking it by a claimed $59 billion. The CBO's other prediction -- that national health care costs would decrease over the long run was lost in the political din.

If Clinton foes then assumed the CBO was on their side, they were soon proved wrong. Early this month, the agency said the so-called Cooper-Breaux compromise that would scrap employer mandates would not achieve universal coverage -- and would be costly, regulatory and complex.

Having thus established that health care proposals from any quarter will have to pass harsh muster, the CBO is hard at work analyzing competing measures. One of the latest, crafted by Sen. Edward M. Kennedy, D-Mass., would exempt small employers from paying mandated health insurance. The president, fighting off allegations of personal misconduct and juggling three or four international crises, found it necessary to embrace the Kennedy approach, especially after two moderate Democrats defected to a Republican alternative.

Health care reform clearly will require an all-out comeback fight, even greater than Mr. Clinton's triumphs on trade and gun control bills, if a beneficial measure is to emerge as the defining achievement of his presidency. The CBO will be watching.

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