The Politics of Health Care

July 31, 1994

More and more, the health care reform battle is turning into a political crap shoot. Both Democrats and Republicans feel in their craw that how this titanic struggle turns out will mightily affect how their parties fare in the November election and probably in 1996 as well. But the issue is so complicated, the imponderables so numerous, the stakes so high that even those intimately involved cannot predict the outcome -- or its consequences.

With congressional elections only 100 days away, legislating is even more supercharged by partisanship than usual. There are plenty of serious, committed lawmakers trying to fashion a compromise that will meet the nation's needs. But others are trying to load the health care bill with baubles -- local projects and payoffs -- that will make it look like a Christmas tree. And party managers are focused strictly on winning and losing.

Some Democrats want a go-for-broke approach close to President Clinton's original proposal for health insurance coverage for all Americans; they figure that if they win they win and if they lose the Republicans lose. "Passing a health care reform bill is very important to the Democrats both substantively and politically," says House majority caucus chairman Steny Hoyer.

Conversely, some GOP strategists seem intent on beating Mr. Clinton on the issue he has chosen to define his presidency, figuring this would be bound to help Republicans on the $H hustings. "Those stray Republicans who delude themselves that there is still a 'mainstream' middle solution are merely pawns in the Democratic game," says GOP consultant William Kristol. Yet Republican fears of being targeted as obstructionists are genuine enough. A Wall Street Journal/NBC poll shows that health care is the only key issue on which Democrats have a clear edge over Republicans.

As if to demonstrate how political the health care issue has become, First Lady Hillary Rodham Clinton is trying to resurrect the spirit of the 1992 post-convention bus trips that gave her husband's presidential campaign a touch of magic that led to the White House. Her "Health Security Express," however, is drawing mixed responses.

Catcalls from anti-abortionists are only part of Mrs. Clinton's troubles; another is that there is no specific bill she can tout. Democratic leaders in the Senate and House are introducing measures so unlike that House Democrats are insisting on a Senate vote for employer mandates before they go out on a limb. Her husband, meanwhile, is desperately seeking a compromise he will not have to veto from Republicans who keep edging "further away." Such is the state of combat as Congress braces for fierce floor debate in the next fortnight.

What is taking place is not pretty and not a civics textbook example of how laws should pass. But it is very much in the spirit of our times, with emphasis not so much on the substance of public questions too complicated for sound bites but on how they they will play in the political arena.

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