After 10 days of watching his health-care plan pummeled by critics in the private sector and splashed with red ink by the nonpartisan Congressional Budget Office, President Clinton is at a crossroads.
He must help craft a political strategy to salvage the core of his plan-particularly his promise of universal insurance coverage-or watch the debate in Congress move past the restructuring of America’s health-care delivery system designed by his wife, Hillary Rodham Clinton.
History and political reality suggest the administration will take the most conciliatory route, despite Clinton’s promise during his State of the Union address to veto any legislation that does not guarantee universal coverage.
The recent spate of bad news has sparked an internal administration debate over whether to present an uncompromising front on the original plan or accede to the less-than-tender mercies of the congressional process.
Inside the White House, the first lady and her health-care adjutant, Ira Magaziner, are leading the fight to hold on to substantial elements of the plan.
Capitol Hill observers suspect that is a battle Magaziner and Mrs. Clinton have already lost.
However, many of Clinton’s senior advisers, including George Stephanopoulos and David Gergen, are comfortable with casting aside much of the administration proposal in the interests of getting some credible measure of reform out of Congress this year-perhaps with no more than the promise of eventual universal coverage.
“We are in no way passive in this process,” Treasury Secretary Lloyd Bentsen insisted Thursday. “We are pushing our point of view, and our schedule for passing the legislation.”
Still, Bentsen acknowledged that compromise over a wide range of issues, including the fate of an alternative Democratic plan offered by Rep. Jim Cooper of Tennessee, would likely be settled in a congressional committee.
“What you’re going to see on any major piece of legislation is substantial modification,” Bentsen said, “particularly when so many different people have so many different views.”
The president’s Health Security Act begins its trek through Congress at a moment when it is under a withering attack in a series of television ads sponsored by the health-care industry.
Worse for the White House, last week’s Congressional Budget Office report, which indicated that the proposal would boost the budget deficit by $74 billion over six years, delighted the plan’s opponents.
With Republicans cackling over the Big Government, tax-and-spend ammunition that the report supplied them, the underpinnings of the Clinton plan-employer mandates and a complex system of regional alliances to purchase insurance for consumers and employers-appear to be at risk.
A day after the report was delivered to Congress, Democrats were gamely talking about scaling back the scope of the Clinton plan in the interests of cutting costs. A Clinton adviser told The Washington Post, “We’re going to have to compromise, so we might as well do it sooner rather than later.”
Clinton’s congressional allies maintain that while the adminstration will have to live with whatever Congress ultimately delivers, it should in no way be viewed as a setback or a rebuke. It is simply the way things get done in Washington, they insist.
“The whole legislative process is just beginning,” House Speaker Tom Foley (D-Wash.) said last week. “It’s not going to be a choice between A Plan and B Plan. There will probably be some changes as we go along.”
Clinton’s brief track record on Capitol Hill is mixed, but it does reflect a willingness, even an eagerness, to compromise. It is a characteristic that has disturbed many in his party.
Through deft bargaining and outright political payoffs, Clinton resurrected the North American Free Trade Agreement, harnessing enough Democratic support in the House to earn passage.
However, his “economic stimulus plan,” touted in his first speech to Congress in 1993, failed to generate enough to even force a vote in the Senate. It collapsed, much to the dismay of liberal Democrats, abandoned in the interests of saving his five-year deficit-reduction plan.
In a strategy that may presage the Clinton approach to health-care legislation, the administration all but turned over the particulars of its $500 million deficit-reduction program to Democratic congressional barons.
When the plan emerged, the president pronounced the mix of tax hikes and spending cuts to his liking, claiming victory after Vice President Al Gore cast the tie-breaking vote in the Senate.
If the administration has decided to live with a health plan crafted and delivered by Democrats such as New York Sen. Daniel Patrick Moynihan, who chairs the Senate Finance Committee, and Illinois Rep. Dan Rostenkowski, chairman of the House Ways and Means Committee, they have not declared a truce in the public relations battle.
As they did during the NAFTA fight, they remain on a campaign footing, constructing a “health-reform delivery room” inside the White House complex to coordinate the congressional lobbying effort, generate public support and provide rapid response to critics and attacks.
Administration officials believe that despite the recent setbacks, the broad outlines of Clinton’s plan retain their public appeal.
They cite as evidence that the Republicans have largely abandoned one strategy and instead built on the idea that there is no national health-care crisis in the country and that sweeping change would do more harm than good.
That perspective, offered most notably by Senate Republican leader Bob Dole of Kansas in his response to Clinton’s State of the Union address, has not resonated outside Washington.
In a Newsweek magazine poll released last week, for example, 79 percent of those asked said there “is a health-care crisis in this country today.” And 73 percent of those surveyed approved of the idea of universal health insurance for all Americans-the point Clinton offered as his bottom line.
The public mood will be on the mind of lawmakers in both parties when they return to their districts Monday for a weeklong recess.
According to a senior House Democratic staffer: “The most damaging thing that could happen to health care is for these guys to go home and hear from their constituents that, “If it’s going to be this costly and this disruptive, it’s not that important to me.’ So far, they haven’t heard that.”
