Showdown time on health care legislation finds the citizenry confused, Congress groping desperately for a consensus or a fig leaf and Hillary Rodham Clinton's elaborate proposals heading for the Capitol Hill butcher shop. What, if anything, emerges will depend more on political fear factors than on widely supported reforms to fix a system that leaves millions of Americans uninsured.
One thing seems clear: Universal coverage by whatever means will not come quickly. There will be no instant requirement that all employers pay 80 percent of their employers' health insurance costs, no regional alliances to manage health care competition that all citizens will have to join, no federal caps on health care spending that could lead to price controls.
These features of the Clinton plan still have some appeal in Congress, but largely as ultimate goals if more voluntary and modest approaches fail. Many legislators acknowledge a large gap between the perception of the problem and what is politically feasible to solve it. Hence, if there is to be legislation this year -- legislation that is supposed to define the Clinton presidency -- it will require the lowest common denominator for what constitutes universal coverage.
There are some Democrats who would like to go to the polls in November blaming the Republicans for obstructing health care reform. But their leaders seem to realize this is a shaky position for a party in control of the White House and Congress. There are some Republicans eager to slap down the president, but a number of GOP lawmakers, perhaps sufficient to produce a bipartisan majority, see grave dangers in such a course.
So by the July 4 recess, something has to happen. And with former House Ways and Means committee chairman Dan Rostenkowski sidelined by a 17-count corruption indictment, Sen. John Breaux, D-La., has come up with an idea that may provide the cover incumbents crave to avoid the wrath of worried constituents.
Senator Breaux would make modified features of the Clinton health plan voluntary rather than mandatory for a period of up to five years. If the number of uninsured still exceeds stated targets by that time, "triggers" would be activated -- and what has been voluntary would become mandatory. Democrats from President Clinton on down have given this approach a guarded thumbs up. But it will really be up to Senate Finance Committee chairman Daniel Patrick Moynihan, D-N.Y., and moderate Republicans on his committee to produce a measure ready to go to the floor after the Fourth of July recess. Three House committees are still at work, but Mr. Rostenkowski's troubles put the Senate in the driver's seat.
This newspaper remains convinced that health insurance reforms are needed so that all citizens can obtain reasonably priced coverage. Congress and the president can still take a first step this year, even if the long journey is far from complete.