Healthy Dissent

By Dan Goodgame/Washington

You can tell that Congress is serious about health-care reform when the debate starts turning personal. Last week it moved past the jargon about "provider networks" and "community ratings" to the discomfiting question of Senator Arlen Specter's brain tumor -- specifically, whether the average health plan under a Clinton system would have allowed him the expensive scan that he recently demanded against the advice of his doctor and that he credits with saving his life. (Answer: Probably not.)

That Specter, a Pennsylvania Republican, should publicly ponder the personal impact of health-care reform is remarkable, considering that Congress often exempts itself from the laws that it imposes on the rest of America. But now two lawmakers are challenging their colleagues to obtain health care for themselves and their families through the same penny-pinching managed-care plans that many of them, following the lead of President Clinton, are prescribing for other Americans. Representative Pete Stark, a California Democrat, wants to require Congressmen to enroll in the cheapest health-care plan offered in their home districts. Senator Paul Wellstone, a Minnesota Democrat, proposed a similar amendment in the Senate. Says Stark: "If managed-competition organizations are the answer to the nation's health-care problems, why aren't more members of Congress, the President and his Cabinet in them?" Neither Stark nor Wellstone supports the Clinton plan -- a hybrid beast that would employ both market competition and bureaucratic regulation in an effort to cover all Americans and cut costs. Both lawmakers belong to the group of liberal Democrats who would prefer some version of a single-payer system similar to the one in Canada, where the government pays everyone's health-care bills through tax revenue. That plan would be simpler than either the present mess or the Clinton proposal; it would achieve more savings (by eliminating insurance companies) and would assure Americans equal access to health care. But single-payer medicine would require explicit government rationing of care. And it would grant new powers to a government that most Americans say they don't trust to carry out its current assignments.

By raising the explosive issue of whether Washington politicians will share in the sacrifice they ask of other Americans, Stark and Wellstone hope to attract attention to alternatives to the Clinton plan. And they have succeeded, not only on behalf of liberals, but also on behalf of conservatives who would turn the burden-sharing question on its head. Why, they ask, should the public not get health insurance through the sort of market-based program that already provides quality, choice and cost control for Congress and other federal employees?

What the conservatives, led by the Heritage Foundation and a handful of Republican lawmakers, have in mind is one of the capital's best-kept secrets: the Federal Employees Health Benefits Program, which covers nearly 10 million federal workers, from the Clinton Cabinet and members of Congress to stenographers, janitors and 2 million retirees and their spouses. Federal workers decide which services they want covered by their insurance, choosing annually from dozens of policies available in their community. They pay about a third of the premium, and the government pays the rest.

Founded 33 years ago, the federal program boasts an enviable record of cost control: its premiums will increase an average of just 3% next year. Stuart Butler, a health-care expert at Heritage, describes the plan as "an established, consumer-driven system that works."

The Heritage plan, proposed last year by Utah Senator Orrin Hatch, would target one of the biggest factors driving up health-care costs: the $70 billion-a-year federal tax deduction that encourages employers to purchase more health insurance for their workers than they would otherwise, which discourages workers from seeking the best value for money in medical care. Heritage would shift that tax break -- worth about $800 a year to the average family -- from employers to individuals, as a progressive, refundable tax credit, similar to the one now available for child care. It would require all Americans to carry insurance for "catastrophic" medical bills costing more than $3,000 a year. And it would provide generous subsidies for those who cannot afford insurance. Still, precisely because it relies on the market, it could not guarantee universal coverage or specific savings.

As a matter of practical politics, neither these conservatives nor the liberal supporters of a single-payer system expect that their plans will win out over Clinton's. But both sides are working to broaden the debate -- and pull the Clinton plan in their direction. They also are acting as if the outcome matters to them personally, which in Congress is breathtaking news.

With reporting by Julie Johnson and Dick Thompson/Washington