Hard or Soft Trigger? Cracking the Health Debate Code

July 24, 1994|By KAREN HOSLER

Washington. -- Hard trigger. Soft trigger. Roy Rogers and Trigger. The debate over restructuring the nation's health care system is beginning to sound like the shootout at the OK Corral.

Which it sort of is, politically speaking. The stakes are very high for President Clinton, the members of Congress and virtually every American. All will be affected by whatever legislation emerges -- or fails to -- before the matter is resolved this year.

Still to be answered are such difficult questions as whether health insurance coverage will be provided for everyone, by what date, and who will pay for it. Looming large over the process are the concerns of those already covered by insurance who fear they will wind up worse off.

Thus, the inevitable Washington jargon that has been coined as the common tongue of health care reform serves two purposes: It provides a short-hand means of expressing complicated concepts, and it puts a political slant on certain tactics to suit the needs of the user.

For example, Mr. Clinton likes to call his proposal that employers be required to help their workers buy health insurance "shared responsibility." Senate Republican leader Bob Dole of Kansas likes to call it a "tax increase."

For most of this month, Senate Majority Leader George J. Mitchell of Maine and House Majority Leader Richard A. Gephardt of Missouri will be engaged in the toughest job either of them has ever faced. They are trying to combine competing health care reform proposals passed by four separate Senate and House committees into a form they believe can be passed by their respective chambers.

Mr. Mitchell will bring his plan to the Senate floor to face the prospect of unlimited amendments and a possible filibuster. Mr. Gephardt has the advantage of more structure and time limits, but he needs to find 218 votes from a pool of only 256 Democrats.

Herewith is a glossary of some of jargon likely to be tossed about as each house of Congress struggles to pass a version of the health care legislation by the mid-August recess.

* UNIVERSAL COVERAGE -- This sounds so simple: everybody covered. But universal coverage has become the slipperiest phrase in the entire debate because Mr. Clinton has threatened to veto a bill that does not provide for it. Mr. Clinton has had to adjust his own definition several times already to keep his bluff from being called.

Just last week, Mr. Clinton appeared to lower the bar again by suggesting that guaranteeing health insurance to 95 percent of the population might still be considered "universal" coverage -- at least in the short run. About 85 percent of Americans have health insurance today.

But after liberal Democrats and some party leaders protested the president was caving in too soon, Mr. Clinton abruptly reversed course. Stay tuned.

* UNIVERSAL ACCESS -- This is an alternative goal invoked by opponents of the Clinton plan who don't want to force anyone to buy health insurance but hope to make it more affordable and thus easier to obtain. Hillary Rodham Clinton notes that Americans have universal access to Mercedes automobiles, yet that doesn't put them in the driver's seat.

* SINGLE PAYER -- The simplest and probably most effective means of providing universal coverage, this proposal calls for enrolling all Americans in a government-run program financed by a substantial new tax. Mr. Clinton rejected this approach, similar to the Canadian health system, because he didn't consider it "feasible." Strong advocates of this approach remain, however, among the most liberal ranks of the Democrats. They are digging furiously to prevent a total capitulation by Mr. Clinton to moderates and conservatives.

* EMPLOYER MANDATE -- A lesser-of-the-evils option Mr. Clinton decided was a more practical means than direct taxes to finance universal coverage: making firms pay 80 percent of the cost for their workers. Though polls show most Americans support the idea, small business lobbyists have waged a highly effective campaign, claiming that the "mandate" would force their clients to lay off workers or go out of business altogether. No Republicans are supporting the concept.

* INDIVIDUAL MANDATE -- A third financing option that would require individuals to buy their own insurance if employers do not provide it. Mr. Clinton included this in his proposal to apply to the self-employed and others not covered by the employer mandate.

One Republican plan included individual mandate -- instead of, rather than as a supplement to, an employer mandate -- on the theory that, like automobile insurance, every citizen has a responsibility to obtain health coverage. That concept also came under sharp attack as a "tax increase." But some requirement is considered necessary to guarantee that young, healthy people remain in the pool of insured to offset the greater expenses of the ill and elderly.

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