Better Off Dead?

By Dan Goodgame/Washington

The pitch sounded so straightforward and practical in those TV commercials aired by the Republican Party over the summer. "We can make health insurance affordable now, without the Clinton government-run system . . . If you lose your job, you won't lose your coverage . . . Let's do it now!" That message, polls show, has resonated with the 85% of Americans who already have health insurance. Their priority, by and large, is to make their own coverage more secure and affordable, rather than to finance elaborate subsidies for the uninsured. And now that they have beaten back the major overhaul of health care that Democrats had proposed, one would expect Republicans to seize their moment.

Instead, as Congress straggles back to Washington this week, Senate minority leader Bob Dole and other Republicans are backing away from the "simple insurance reforms" they have touted for months. Republican Party chairman Haley Barbour, who commissioned the "Do it now" ads, told reporters last week that it would be better for Congress to do nothing on health this year, rather than attempt a last-minute compromise. The main reason for this retreat -- as some cynical lawmakers have known all along -- is that there is no simple way to make health insurance secure, affordable and portable. One reason is the seesaw effect: forcing down insurance costs for older Americans and those who get sick can force insurers to raise premiums beyond the reach of many among the young and the healthy. Result: growing ranks of uninsured.

Pivotal lawmakers and many of Clinton's top advisers predicted last week that none of the incremental reforms now before Congress looks likely to attract majority support, mostly because each bill might cause more problems than it solves. What is left of the health-care debate for this season, then, is in large part political positioning for the battle's rejoining next year.

To be sure, a handful of lawmakers is still trying to pass some worthwhile, if limited, reform in the four to six weeks remaining in this Congress. President Clinton hasn't stopped encouraging the labors of Senate majority leader George Mitchell, who retires this year and turned down an appointment to the Supreme Court in order to push for health reform. Mitchell remains committed to fight for any helpful reform he can get, as does a shrinking band of moderate Republicans led by Rhode Island Senator John Chafee. Ted Kennedy, the Massachusetts Democrat, is one of the diehards. He told TIME, "I've never thought the best should be the enemy of the good." And Ira Magaziner, chief architect of the now abandoned Clinton plan, is gamely working with Senator Harris Wofford of Pennsylvania and other Senate liberals on a "Kids First" plan to extend insurance to children who now lack it. All these players are wearing their game faces; they expect the health-care struggle to continue right through Congress's scheduled Oct. 7 adjournment.

But after a White House strategy session among a dozen of the Clintons' top health and political advisers last Wednesday night, an official summed it up: "There was a lot of doubt that we're going to get anything meaningful this year." And next year will only be tougher, with more Republicans expected to be elected to Congress in November. Clinton's supporters console themselves by noting that he isn't likely to be tested on his stern, fountain-pen-wagging threat to veto any bill that fails to guarantee universal coverage. "At least," said a political adviser, "he probably won't have to eat his pen."

Senator Joseph Lieberman, a Connecticut Democrat who consults closely with the White House on health care, said he was getting an ominously fuzzy message. "If I'm getting any signals at all," he said, "it is in the direction of folding up the tent" for this year. In Congress, he observed, "people who want to do nothing and people who want to do too much are peeling off," leaving only a minority interested in modest steps and compromise. One of those splitting off on the left was Representative Jim McDermott, a Democrat from Washington State who favors a "single payer" health system in which the government pays all medical bills from tax revenue. He declared last week that he could not support any incremental reforms, observing that Congress is "getting into that political mode where you want to do something just so that it looks like you've done something. That's often when we create the worst policy."

Meanwhile, Republican leader Dole, who last year endorsed Clinton's call for universal coverage and then supported Chafee's efforts for bipartisan accord, kept backing away from both men last week. During his travels around the country in recent weeks, Dole said, he has detected in the public mood that "health care has sort of disappeared from the radar screen as a big issue." Dole also cited the proximity of the October recess. "Every time you look at health care in that context, it looks smaller and smaller."

Nonetheless, Senators Mitchell and Chafee this week will resume their efforts to amend Chafee's bipartisan "mainstream" bill in ways that might attract majority support. One of the bill's most controversial provisions would reduce the federal-tax break for many of those who obtain health insurance through their employers. This tax subsidy costs the Treasury $74 billion a year, fuels health-care inflation and disproportionately benefits workers with the most generous health plans. Capping this tax break is widely considered good policy but bad politics, and is unlikely to win the approval of more than 40 Senators.

Another troublesome section of the mainstream bill would limit the ability of insurance companies to raise premiums on policyholders as they age, fall ill and change jobs. That would force insurers to raise premiums on the healthy and the young, who on average earn far less than their elders. Because the bill does not mandate that all Americans carry insurance, many of the young and healthy would probably drop their coverage. That has been the experience in New York State, which instituted a similar "community-rating" system last year and found its pool of policyholders growing older, sicker and more expensive to cover.

For these and other reasons, even Senator Daniel Patrick Moynihan, whose Finance Committee gave birth to the mainstream bill, gives it little chance of passage. Harold Ickes, the chief White House strategist for health legislation, has warned Clinton that he should avoid embracing the mainstream bill lest he be identified with another failure. At the same time, Leon Panetta, the new White House chief of staff and a veteran of Congress, warns that the President must not write off the efforts of key lawmakers. Upshot: Clinton is left to cheerlead in hoarse whispers from the sidelines.

Several less ambitious bills that attempt to reform health insurance also risk making it worse. These include bills introduced by Dole and Senator Bob Packwood, the Oregon Republican; by House minority leader Bob Michel; and by a bipartisan group of House members with the unwieldy label of Rowland- Bilirakis-Cooper-Grandy. None stands much chance of passage.

Critics of incremental reform explain that health care contrasts sharply with most legislative issues because it does not easily submit to the go-slow, split-the-difference culture of Congress. Senator Patty Murray, the Washington State Democrat, compares the process to "putting a 10-m.p.h. speed limit on ambulances -- it's costly, and it's dangerous."

Several liberal lawmakers are trying to frame an incremental reform that would achieve universal health coverage for at least one emotionally important constituency: children. Leading the effort is Wofford, who would provide full government funding to insure all children in families below the poverty line (now $14,764 for a family of four) and would offer partial subsidies sufficient to insure children in families that have incomes perhaps four times more than the poverty level. "It probably wouldn't cover that many more people," says an Administration health expert, "but Congress and the President could say, 'Hey, we got a start on universal coverage and did some good for a group that almost everybody wants to help.' "

Wofford, whose come-from-behind Senate victory in 1991 first identified health care as a hot campaign issue for Bill Clinton, accepts that the public is not ready for major reform this year. But he adds some fighting words. If Congress cannot agree on at least some small step toward health reform this year, he will sponsor a bill to disqualify lawmakers from the Federal Employees Health Benefit Plan. "It's simply wrong," Wofford argues, "for members of Congress to have health benefits paid for by their employer -- the taxpayers -- when many of those who actually pay the taxes have no such benefits themselves."

CHART: NOT AVAILABLE

CREDIT: From a telephone poll of 800 adult Americans taken for TIME/CNN on Aug. 31-Sept. 1 by Yankelovich Partners Inc. Sampling error is plus or minus 3.5% Not Sures omitted

CAPTION: Do you think the country's health-care system needs a great deal of reform?

Which one of the following is most responsible for the failure to pass a comprehensive health-care reform plan?

With reporting by Julie Johnson and Dick Thompson/Washington